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In medically complex patients with severe systemic illness and hypoalbuminemia, succinylcholine can cause prolonged apnea due to suspected acquired reduction in butyrylcholinesterase activity, and qualitative train-of-four monitoring is insufficient to guarantee adequate neuromuscular recovery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 23, 2026CureusOpen Access

Unexpected Prolonged Apnea Following Succinylcholine in a Medically Complex Patient: A Case Report

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SLSharlette Lynch

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Implication

Case report reveals prolonged apnea following succinylcholine administration in a patient with severe systemic illness, highlighting the inadequacy of qualitative train-of-four monitoring.

Key Points

To report a case of unexpected prolonged apnea and neuromuscular weakness following succinylcholine in a medically complex patient and evaluate diagnostic challenges surrounding delayed recovery.
Documented the clinical presentation, airway management, and diagnostic workup of a 69-year-old male who developed profound ventilatory failure following endoscopy under total intravenous anesthesia.
Evaluated neuromuscular recovery using qualitative train-of-four monitoring, naloxone administration, head computed tomography, and supportive intensive care ventilation.
The patient developed severe ventilatory weakness (respiratory rate ~3 breaths/min, tidal volume ~30 mL) approximately two hours post-induction despite displaying four qualitative twitches without detectable fade.
Full neuromuscular recovery required intensive care mechanical ventilation for five hours and 37 minutes following emergency reintubation.
Severe systemic illness and hypoalbuminemia pointed toward an acquired deficiency in butyrylcholinesterase activity as the primary driver of delayed succinylcholine clearance.

Cite This Study

Sharlette Lynch (2026) studied this question.

synapsesocial.com/papers/6a8aae337677a34114447099 https://doi.org/10.7759/cureus.114907

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Implication

Case report reveals prolonged apnea following succinylcholine administration in a patient with severe systemic illness, highlighting the inadequacy of qualitative train-of-four monitoring.

Unexpected Prolonged Apnea Following Succinylcholine in a Medically Complex Patient: A Case Report

Discussion

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Implication

Key Points

Cite This Study

Unexpected Prolonged Apnea Following Succinylcholine in a Medically Complex Patient: A Case Report

Discussion

Member takes

Implication

Key Points

Cite This Study

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