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Cocaine and Succinylcholine Sensitivity

A New Caution

Peter Jatlow, MD^*, Paul G. Barash, MD, Craig Van Dyke, MD, Joel Radding, MS, and Robert Byck, MD^||

*Professor of Laboratory Medicine and Psychiatry. Departments of Laboratory Medicine, Anesthesiology, Pharmacology, and Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06510 Associate Professor of Anesthesiology. Departments of Laboratory Medicine, Anesthesiology, Pharmacology, and Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06510 Assistant Professor of Psychiatry. Departments of Laboratory Medicine, Anesthesiology, Pharmacology, and Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06510 Associate in Research, Department of Psychiatry. Departments of Laboratory Medicine, Anesthesiology, Pharmacology, and Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06510 ||Professor of Psychiatry and Pharmacology. Departments of Laboratory Medicine, Anesthesiology, Pharmacology, and Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06510

Abstract

Cocaine was stable (93.6 ± 5.0 (SD) % remaining after 120 minutes) when incubated in plasma from six patients with histories of succinylcholine sensitivity and low dibucaine numbers (phenotype A), but was rapidly hydrolyzed (40.6 ± 6.6% remaining after 120 minutes) when incubated in plasma obtained from normal subjects (phenotype U). Intermediate decay (69.4 ± 9.0% remaining) occurred in three heterozygous offspring of the succinylcholinesensitive patients. Since serum cholinesterase has recently been implicated in the human metabolism of cocaine, patients who are homozygous for the atypical enzyme may be at greater risk for a toxic reaction when administered this drug. We recommend caution in using cocaine for topical anesthesia in patients with histories of succinylcholine sensitivity or low dibucaine numbers.

Key Words: ANESTHETICS, Local: cocaine • BIOTRANSFORMATION (DRUG): cocaine • ENZYMES: pseudocholines-terase

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999