An Unusual Cause of Recurrent Laryngeal Nerve Monitoring Failure during Parathyroidectomy

Intraoperative monitoring of the recurrent laryngeal nerve (RLN) during surgical dissection allows for real time identification and assessment of nerve function integrity. Since neuromuscular blockade interferes with electromyography, long-acting muscle relaxants cannot be used during anesthesia. We report a patient in whom monitoring of the RLN was unsuccessful because of prolonged muscle paralysis following the administration of succinylcholine, presumably due to a pseudocho-linesterase deficiency.

laryngeal nerve monito-ring, muscle paralysis, pseudocholi-nesterase deficiency

1. Hemmerling TM, Schmidt J, Bosert C, Jacobi KE, Klein P. Intraoperative monitoring of the recurrent laryngeal nerve in 151 consecutive patients undergoing thyroid surgery. Anesth Analg 2001;93:396-9.

2. Harada T, Shimonaka H, Yamamoto M, Akamatsu S, Kasamatsu M, Gotoh M, et al. Succinylcholine neuromuscular blockade in a case of pseudocholinesterase variant. Masui 1989;38:791-6.

3. Viby-Mogensen J. Succinylcholine neuromuscular blockade in subjects homozygous for atypical plasma cholinesterase. Anesthesiology 1981;55:429-34.

4. Whittaker M. Plasma cholinesterase variants and the anaesthetist. Anaesthesia 1980;35:174-97.

5. Harris H, Whittaker M. Differential inhibition of human serum cholinesterase with fluoride: recognition of two new phenotypes. Nature 1961;191:496-8.

6. Soliday FK, Conley Y, P., Henker R. Pseudocholinesterase deficiency; A comprehensive review of genetic, acquired, and drug influences. AANA Journal 2010;78:313-20.