Prolonged Apnea After Ect In Organophosphorus Poisoning – The Need To Redefine Norms

Abstract Background:Organophosphorous (OP) compounds act by irreversibly binding to pseudocholinesterase enzyme and hence prolong the apnea in patients being given suxamethonium. We present a case in which prolonged apnea ensued in a patient of severe depression following ECT in which suxamethonium was used as muscle relaxant, in whom we were cautious of the effect of organophosphorus poisoning.Case Presentation 53/F patient consumed OP 38 days prior to ECT. Since existing literature recommend a delay of 4 weeks and a subminimal dose of suxamethonium to prevent prolonged apnea, both these points were taken into consideration. Despite 38 days post exposure to OP, and a dose of succinylcholine of <0.3mg/kg, the patient remained apneic for 3 hours. Subsequently her pseudocholinesterase levels were also found to be very low.Conclusion This case is being presented to emphasize that behaviour of post synaptic receptors cannot be relied upon after OP poisoning and pseudocholinesterase levels needs to be mandatorily checked, irrespective of duration post-exposure.