Break the Spasm with Succinylcholine, but Risk Intraoperative Awareness with Undiagnosed Pseudocholinesterase Deficiency

Table 2

Timeline.

Time	Event
09: 35	IV induction with 200 mg propofol, 50 mg rocuronium, and 100 mcg fentanyl
09: 39	Intubation
09: 54	Procedure start
10: 34	Procedure end, 4/4 twitches on TOF monitoring after reversal with sugammadex
10: 35	Emergence
10: 40	Extubation; laryngospasm; 40 mg IV succinylcholine administered
10: 50	No spontaneous respiratory effort; blood pressure increased from 100/57 to 175/22 and heart rate from 64 to 127; 0/4 twitches on recheck of TOF
10: 51	Midazolam 2 mg and propofol 100 mg IV administered; the patient was reintubated and started on a propofol drip
11: 33	Transport to PACU intubated and sedated
11: 40	Labs for dibucaine number and plasma cholinesterase sent
13: 30	4/4 twitches on TOF monitor, sedation weaned, patient extubated once awake and following commands
16: 05	Patient reports well-controlled pain and no awareness of perioperative events