Q. Outline possible reasons for prolongation of paralysis imduced by anintravenous dose of 1 mg/kg of suxamethonium. Briefly indicate theconsequences of such prolonged block.
Overview
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1 mg/kg is normal intubating dose of suxamethonium
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Therefore , phase 11 block is unlikely
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Thus the factors that may prolongation the effect of suxamethonium is theabnormalities in the metabolism of suxamethonium
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Suxamethonium is metabolised by pseudocholinesterase
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Therefore , the alteration in concentration and activity of the enzymes ----result--prolongation of effect of suxamethoniumAcquired enzymes deficiencyOverviewCauses
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Liver disease
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Pregnancy
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Drugs interactionBut
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However, the acquired enzymes defieciency is not often clinically significant causesInherited enzymes defieciencyOverview
Overview
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dibucaine number, the percentage inhibition of plasma cholinesterase produced by astandard titre of dibucaine = 10-5 mmol/lFunction
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the degree of inhibition of hydrolysis by dibucaine allow one to differentiate betweennormal patinet and patient with atypical pseudocholinesterase enzymeImplication
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if abnormalities are found, the entire family should be testedMechanism
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Plasma of healthy that experienced prolonged response with suxamethoniumcontained abnormal enzymes
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The atypical enzyme able to hydrolysis the test substance but unable to hydrolysesuxamethonium
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Local anesthesia chichocaine ( dibucaine ) able to inhibit hydrolysis ofbenzocholineDefinition
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A test for differentiation of one of several forms of atypicalpseudocholinesterases that are unable to inactivate succinylcholine at normalrates;
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based on the percentage of inhibition of the enzymes by dibucaine,
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