[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-455216-105":59,"doc-detail-455216-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","prolonged-postoperative-paralysis-following-elective-tonsillectomy-a-case-of-pseudocholinesterase-deficiency","Prolonged Postoperative Paralysis Following Elective Tonsillectomy - A Case of Pseudocholinesterase Deficiency","","Pseudocholinesterase deficiency is a rare enzyme disorder that can cause delayed emergence after exposure to depolarizing neuromuscular blocking agents. A case report describes a 19-year-old male who underwent elective tonsillectomy and developed prolonged postoperative paralysis, suspected to be due to pseudocholinesterase deficiency. The patient reported no significant personal or family history. The report emphasizes clinical implications and perioperative management strategies to improve patient safety.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/prolonged-postoperative-paralysis-following-elective-tonsillectomy-a-case-of-pseudocholinesterase-deficiency/455216/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/prolonged-postoperative-paralysis-following-elective-tonsillectomy-a-case-of-pseudocholinesterase-deficiency/455216.png","ImageObject",300,407,{"name":92,"@type":93},"A glass of water","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What disorder is suspected in the case of prolonged paralysis after elective tonsillectomy?","Question",{"text":112,"@type":113},"The case attributes the prolonged postoperative paralysis to pseudocholinesterase (butyrylcholinesterase) deficiency.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does pseudocholinesterase deficiency affect anesthesia recovery?",{"text":117,"@type":113},"Reduced enzyme activity slows hydrolysis of depolarizing neuromuscular blocking agents, leading to delayed overall recovery, prolonged paralysis, and possible apnea.",{"name":119,"@type":110,"acceptedAnswer":120},"What management focus is highlighted for perioperative care?",{"text":121,"@type":113},"The report highlights the need for anesthesiologists and surgeons to anticipate unexpected delayed emergence and use strategies for perioperative management when this condition is suspected.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},455216,1790742396,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":52,"preview_page_count":4},962090760832,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review began 11/11/2025  \nReview ended 12/03/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nWalsh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98727  \nOpen Access Case Report  \nProlonged Postoperative Paralysis Following Elective Tonsillectomy: A Case of Pseudocholinesterase Deficiency  \nKade Walsh 1, Shane Smith 2 , Gabriella Manilla 3, Jatin Ahluwalia 3, Robert Stachler 4  \n1. Otolaryngology-Head and Neck Surgery, Rocky Vista University College of Osteopathic Medicine, Parker, USA 2. Anesthesiology, Rocky Vista University College of Osteopathic Medicine, Parker, USA 3. Otolaryngology-Head and Neck Surgery, Ascension Providence Hospital, Southfield, USA 4. Otolaryngology, Beaumont Hospital, Royal Oak, USA  \nCorresponding author: Kade Walsh, [kade.walsh@co.rvu.edu](kade.walsh@co.rvu.edu)  \nAbstract  \nPseudocholinesterase deficiency is a rare disorder of the enzyme butyrylcholinesterase that can lead to delayed emergence following exposure to depolarizing neuromuscular blocking agents. We report the case of a 19-year-old male who underwent elective tonsillectomy and experienced prolonged postoperative paralysis, suspected to be due to pseudocholinesterase deficiency. The patient had no significant past medical history or family history of the condition. This report highlights the clinical implications of pseudocholinesterase deficiency and discusses strategies for perioperative management.  \nCategories: Anesthesiology, Otolaryngology  \nKeywords: anesthesia complications, delayed emergence from anesthesia, pseudocholinesterase deficiency, succinylcholine, tonsillectomy  \nIntroduction  \nPseudocholinesterase deficiency is a disorder that can lead to unexpected perioperative complications and has profound patient safety implications. Complications can be characterized by apnea and prolonged paralysis following administration of depolarizing neuromuscular blocking agents [1] . The disorder can be acquired or genetic, with the genetic form differentiated into either homozygous or heterozygous forms [1] . The inheritance pattern is autosomal recessive, and is caused by mutations in the butyrylcholinesterase (BCHE) gene on chromosome 3q26.1-q26.2 [1] . Approximately 1 in 3,200 individuals to 1 in 5,000 individuals are estimated to have the disorder in the general population [2] . The acquired form may be attributed to medication use, pregnancy, liver disease, burns, or malnutrition [2,3] . Interestingly, recent literature suggests that Iranian Jews may express the atypical allele at a higher frequency (12 . 1% heterozygous, 0.9% homozygous) relative to the general population [4] . Although genetic forms are present at birth, the average age of diagnosis varies significantly, depending on when the individual is exposed to an inciting muscle relaxant [1] . Therefore, most cases of pseudocholinesterase deficiency arise perioperatively when a patient presents with unexpectedly prolonged paralysis and apnea, as well as delayed overall recovery from anesthesia [1] . Because most patients are asymptomatic until exposed to an offending agent, anesthesiologists and surgeons alike must maintain awareness of this condition to anticipate and manage unexpected delayed emergence.  \nThe most common inciting agents include ester-based neuromuscular blocking agents such assuccinylcholine and mivacurium [5] . Ester-based local anesthetics such as chloroprocaine and procaine have also been noted to have prolonged effects [6] . These drugs are all metabolized via plasma cholinesterases, primarily butyrylcholinesterase in humans [5] . Butyrylcholinesterase is also referred to as pseudocholinesterase or plasma cholinesterase. The enzyme itself is produced in the liver and released into circulation, where it exerts its effect","cbCaiu5gLIGCn04I","https://ap.wps.com/l/cbCaiu5gLIGCn04I","pdf",122087,"English","# Abstract\n# Introduction\n# Case Presentation","[{\"question\":\"What disorder is suspected in the case of prolonged paralysis after elective tonsillectomy?\",\"answer\":\"The case attributes the prolonged postoperative paralysis to pseudocholinesterase (butyrylcholinesterase) deficiency.\"},{\"question\":\"How does pseudocholinesterase deficiency affect anesthesia recovery?\",\"answer\":\"Reduced enzyme activity slows hydrolysis of depolarizing neuromuscular blocking agents, leading to delayed overall recovery, prolonged paralysis, and possible apnea.\"},{\"question\":\"What management focus is highlighted for perioperative care?\",\"answer\":\"The report highlights the need for anesthesiologists and surgeons to anticipate unexpected delayed emergence and use strategies for perioperative management when this condition is suspected.\"}]","Prolonged Postoperative Paralysis Following Elective Tonsillectomy - A Case of Pseudocholinesterase Deficiency | PDF"]