Prolongd apnea may occur in patients with a genertically determined abnormal variant of cholinesterase following intravenous administration of
Succinylcholine
Tubocurarine
Mivacurium
Succinylcholine or mivacurium
Both succinylcholine and mivacurium are completely and rapidly eliminated by plasma cholinesterase. Other nondepolarizing neuromuscular blockers, such as tu­bocurarine, pancuronium, and atracurium, are elimi­nated by renal or hepatic mechanisms or by spontane­ous hydrolysis (atracurium). Patients with genetically determined atypical cholinesterase may be detected by measuring the inhibition of cholinesterase by dibu­caine, a local anesthetic. Dibucaine inhibits the normal enzyme about 80%, but the abnormal variant is inhib­ited only 20%.