Prolonged apnea may occur in patients with a genetically determined abnormal variant of cholinesterase following intravenous administration of
**Core Concept**
Prolonged apnea in patients with a genetically determined abnormal variant of cholinesterase is a significant concern. This condition arises due to the impaired breakdown of a specific anesthetic agent, leading to prolonged neuromuscular blockade. The abnormal variant of cholinesterase, also known as butyrylcholinesterase (BChE), is responsible for metabolizing certain anesthetics.
**Why the Correct Answer is Right**
Succinylcholine is a depolarizing muscle relaxant that is metabolized by butyrylcholinesterase (BChE). In patients with a genetically determined abnormal variant of cholinesterase, the enzyme's activity is reduced, leading to impaired metabolism of succinylcholine. As a result, the drug accumulates in the body, causing prolonged apnea and potentially life-threatening respiratory depression. This is because succinylcholine is not broken down efficiently, allowing it to continue stimulating muscle contraction, leading to prolonged muscle fasciculations and eventually, apnea.
**Why Each Wrong Option is Incorrect**
**Option A:** Pancuronium is a non-depolarizing muscle relaxant that is not metabolized by cholinesterase. Its effects are not significantly prolonged in patients with abnormal cholinesterase variants.
**Option B:** Tubocurarine is another non-depolarizing muscle relaxant that is not metabolized by cholinesterase. Its effects are not prolonged in patients with abnormal cholinesterase variants.
**Option C:** Atracurium is an intermediate-acting non-depolarizing muscle relaxant that undergoes Hoffman elimination, a spontaneous degradation process that is not dependent on cholinesterase activity. Its effects are not significantly prolonged in patients with abnormal cholinesterase variants.
**Clinical Pearl / High-Yield Fact**
When administering succinylcholine, it is essential to consider the patient's family history and genetic predisposition to abnormal cholinesterase variants. Patients with a history of prolonged apnea after succinylcholine administration should be screened for this condition.
**✓ Correct Answer: D. Succinylcholine**