A “HEALTHY” four-year-old girl was left “paralysed” after undergoing a procedure to remove her tonsils.
The cause – known medically as pseudocholinesterase deficiency – has now been detailed in a new medical report.
The girl, of Northern European descent, underwent general anesthesia for tonsillotomy, adenoidectomy, and bilaterial tympanocentesis.
Tonsillotomy is a procedure to remove the tonsils, mainly performed for recurrent tonsillitis, throat infections and obstructive sleep apnea.
In the UK, the NHS performed roughly 37,000 tonsillectomies on children between April 2016 and March 2017.
Adenoidectomy is surgery to remove the adenoids, small lumps of soft tissue located at the back of the nose that are of the immune system.
And bilaterial tympanocentesis invovles puncturing the eardrum to obtain a sample of fluid from the middle ear.
While all three procedures are considered safe and effective, like any surgery, they can carry some risks, including bleeding, infection, and reactions to anaesthesia.
In this case, the girl sustained “apnea and paralysis” because she developed pseudocholinesterase deficiency from anaesthesia – which almost always presents unexpectedly, wrote the report authors.
Pseudocholinesterase deficiency isa rare condition where the body's ability to break down certain muscle relaxants (like succinylcholine and mivacurium) used during anesthesia is impaired.
The girl had been given mivacurium.
The primary symptom is prolonged muscle paralysis after receiving a standard dose of succinylcholine or mivacurium, which can lead to difficulty breathing and potentially require mechanical ventilation.
While the condition can be acquired due to certain medical conditions, medications, or diseases, it can also be inherited genetically – which was the cause in this case.
The girl was transferred to the paediatric intensive care unit for prolonged post-operative ventilatory support and monitoring.
But her breathing tube was no longer needed eight hours later.
No long-term health consequences were noted.
The report authors wrote: “Pseudocholinesterase deficiency is a rare disorder that commonly presents as prolonged apnea and paralysis following general anesthesia after induction with succinylcholine or mivacurium.
“A casual treatment does not currently exist. However, the disorder typically has a benign course, and an excellent prognosis, if supportive management, including prolonged post-operative ventilatory support, can be provided.”
Whilepseudocholinesterase deficiency itself isn't inherently deadly, prolonged paralysis can lead to respiratory failure and potentially death if not managed properly.
Complications of general anaesthesia
GENERAL anaesthesia complications are rare but can be serious. They may be more likely if:
- you already have a long-term health condition
- you smoke
- you're overweight
- the surgery is major or being done in an emergency
Some of the main complications of general anaesthesia include the following.
- A severe allergic reaction called anaphylaxis is rare but if it happens, it can be life-threatening. It can cause a rash, itching, difficulty breathing, and low blood pressure. Your anaesthetist will treat you immediately if you have a reaction.
- Nerve damage can happen if you’re in the same position for too long and your nerves get squashed during the operation. It can cause numbness and tingling, pain, warm or cold sensations, and weakness. Symptoms usually get better within a few months but the damage can be permanent.
- Damage to your teeth or mouth can happen. You can get small injuries to your lips, mouth or tongue. Sometimes teeth and crowns can be chipped, broken, or knocked out.
- Being confused or having memory problems can happen after general anaesthesia. You might even develop delirium. This can be caused by many things, including an infection or the side-effects of medicines. It usually gets better with treatment after a few days. Postoperative cognitive dysfunction is when you have trouble with more complicated mental tasks. It can develop over weeks, months or even years. Most people make a full recovery.
Some people worry about being ‘awake’ during an anaesthetic or being aware of what’s going on during the operation.
This does happen, but it’s rare. It happens in about one in every 19,000 anaesthetics.
It might mean being aware of talking or having something put in your mouth.
A few people are aware of being unable to move and feeling pain.
It usually lasts for a few minutes, but it can be very distressing.
Always tell your anaesthetist after your operation if this has happened to you.
Source: Bupa
