[citation needed] Because it is rare in the general population, pseudocholinesterase deficiency is sometimes overlooked when a patient does not wake up after surgery.
This enzyme abnormality is a benign condition unless a person with pseudocholinesterase deficiency is exposed to the offending pharmacological agents.
[2] The main complication resulting from pseudocholinesterase deficiency is the possibility of respiratory failure secondary to succinylcholine or mivacurium-induced neuromuscular paralysis.
Individuals with pseudocholinesterase deficiency also may be at increased risk of toxic reactions, including sudden cardiac death, associated with recreational use of the aromatic ester cocaine.
Several single-nucleotide polymorphisms in the BCHE gene have been identified, such as the D98G missense SNP chr3:165830741 A->G (Asp to Gly at 98) rs1799807 present in 1% of the populace (e.g. dibucaine-resistant "atypical" enzyme at 41% of normal activity), and the A567T missense SNP chr3:165773492 G->A (Ala to Thr at 567) rs1803274 (common K-variant "Kalow" at -7% of normal activity).
[7] Patients with known pseudocholinesterase deficiency may wear a medic-alert bracelet that will notify healthcare workers of increased risk from administration of succinylcholine, and use a non-depolarising neuromuscular-blocking drug for general anesthesia, such as rocuronium.
In nonmedical settings in which subjects with pseudocholinesterase deficiency are exposed to cocaine, sudden cardiac death can occur.
A relatively high frequency also was reported among Jews from Iran and Iraq, Caucasians from North America, Great Britain, Portugal, Yugoslavia, and Greece.
[4] Multiple studies done both in and outside India have shown an increased prevalence of pseudocholinesterase deficiency amongst the Arya Vysya community.
A study performed in the Indian state of Tamil Nadu in Coimbatore on 22 men and women from this community showed that 9 of them had pseudocholinesterase deficiency, which translates to a prevalence that is 4000-fold higher than that in European and American populations.