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Other Causes of Reduced Pseudocholinesterase Activity Disease states Drugs (e.g., organophosphates, neostigmine , pyridostigmine) Effects: Prolonged paralysis , including diaphragm involvement Risk of respiratory failure Dibucaine Test Used to diagnose enzyme deficiency: Normal: ~80% inhibition Heterozygotes: 5060% Homozygotes: 2030% Management: Maintain sedation and mechanical ventilation Monitor recovery using train-of-four stimulation Other Contraindications History of malignant hyperthermia Conditions predisposing to overexpression of nAChRs, resulting in an increased incidence of life-threatening hyperkalemia, ventricular arrhythmias and acute rhabdomyolysis (Cooperman 1970

Pathological changes such as herniated intervertebral disc, inflammatory factor infiltration, and nerve ingrowth are closely related to pain (Stefanakis et al., 2012

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