In the Operating Room, a 23-year-old female patient with an undiagnosed pseudocholinesterase deficiency is undergoing general anesthesia for a D&E. As the surgical case is completed, the Student Registered Nurse Anesthetist (SRNA) turns the anesthesia off. Still, 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 before beginning an extubation protocol.

Learning Objectives

– Learner recognizes the absence of spontaneous respirations, following commands, and a 0/4 Train of Four
– Learner verbalizes suspected PchE deficiency
– Learner turns anesthesia gas back on and increases ventilator control settings
– Learner recognizes the signs that the patient is ready to be extubated
– Extubates based on the American Society of Anesthesiology Extubation Criteria