n the Operating Room a 23yo female patient undergoing general anesthesia for a D&E due to a spontaneous abortion at 14 weeks gestation has an undiagnosed pseudocholinesterase deficiency. As the surgical case is completed, the Student Registered Nurse Anesthetists (SRNA) turns the anesthesia off, but the deficiency causes the patient to remain under the influence of the paralytic even as the sedative wears off. This is apparent through 0/4 twitches in Train of Four monitoring, the patient’s inability to follow commands or respond physically, tachycardia, and hypertension. The SNA increases anesthesia and waits for the paralytic to wear off, as show by 4/4 twitches, before beginning an extubation protocol.
University of Pennsylvania