Low cholinesterase. Should I be concerned about anesthesia?

Question

I’m scheduled for a tummy tuck, my pre op lab works came baalright except for cholinesterase which is a bit below the minimum standard (6500, normal range 7000-19000) should i be concerned about anesthesia? My surgeon and Anesthesiologist both gave me the ok

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and for providing your lab details. Low cholinesterase levels can be concerning in certain medical contexts, particularly when anesthesia is involved, but the fact that both your surgeon and anesthesiologist have approved you for surgery is very reassuring.

Cholinesterase is an enzyme that helps metabolize certain drugs, including specific types of anesthetics like succinylcholine (a muscle relaxant often used during general anesthesia). Low levels of this enzyme could theoretically lead to prolonged effects of these drugs. However, modern anesthesia protocols rarely rely solely on succinylcholine and can easily adapt to your individual metabolic profile.

Why Your Surgeon and Anesthesiologist Cleared You:
Your Levels Are Mildly Below Normal: A level of 6500 is slightly below the standard range of 7000–19000. This is not critically low, and adjustments in anesthesia management can easily account for this.
Individualized Anesthesia Plan: Your anesthesiologist is aware of your cholinesterase level and can choose alternative medications or dosages to ensure a smooth and safe surgery.
Routine Testing and Monitoring: During your procedure, your anesthesia team will closely monitor your vital signs, oxygen levels, and muscle relaxation to respond promptly to any issues.
What You Can Do:
Communicate Any Concerns: If you’re still anxious, discuss your questions directly with your anesthesiologist before surgery. They can explain how your levels are factored into their anesthesia plan.
Stay Healthy Before Surgery: Maintain a balanced diet, stay hydrated, and follow all preoperative instructions to ensure optimal surgery and recovery conditions.
Final Thoughts:
Low cholinesterase levels are something your anesthesia team will carefully consider but are unlikely to pose a significant issue for your tummy tuck. With proper planning and monitoring, you should have a safe surgical experience.

Wishing you a successful procedure and excellent results!

Sincerely,
J. Timothy Katzen, MD, FACS

Emmanuel De La Cruz, MD · Answer

Low cholinesterase levels can be a concern when it comes to anesthesia, as cholinesterase is an enzyme that breaks down certain medications, including those used in anesthesia. Cholinesterase deficiency can lead to prolonged effects of certain drugs, potentially increasing the risk of side effects and complications.

Here are some key points to consider:

Communication with Anesthesiologist:

Inform your anesthesia team about your low cholinesterase levels during the preoperative assessment. They will take this information into account when planning and administering anesthesia.
Medication Adjustments:

Anesthesiologists may need to adjust the dosage and choice of medications based on your cholinesterase levels. They will tailor the anesthesia plan to ensure your safety and optimal recovery.
Increased Sensitivity to Certain Medications:

Individuals with low cholinesterase levels may experience increased sensitivity to drugs like succinylcholine, which is used as a muscle relaxant during surgery. Prolonged effects of these medications can occur, and adjustments will be made to minimize risks.
Extended Recovery Time:

Due to the potential for prolonged drug effects, individuals with low cholinesterase levels may experience an extended recovery time from anesthesia. Close monitoring during the postoperative period is important.
Individualized Approach:

Anesthesia plans are highly individualized, taking into account various factors such as overall health, medical history, and specific laboratory values. Your anesthesiologist will work closely with you and the surgical team to ensure a safe and effective anesthetic experience.
Preoperative Assessment:

Before surgery, your anesthesia team will conduct a thorough preoperative assessment, including a review of your medical history and laboratory values. This information will guide the development of a tailored anesthesia plan.
It's crucial to communicate openly with your anesthesia team and provide them with comprehensive information about your health history, including any known medical conditions or laboratory abnormalities. This will enable them to take appropriate precautions and make informed decisions to ensure your safety during surgery and anesthesia.

If you have specific concerns about your low cholinesterase levels, consider discussing them with both your surgeon and anesthesiologist during preoperative consultations. They can address your questions and provide you with personalized information based on your individual case.

Daniel Barrett, MD · Answer

Dear Good366547,
it is hard to tell for sure without an examination. You would need to get clearance prior to surgery. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ajaya Kashyap, MD · Answer

Thank You for your query. Low choline esterase , marginal as it is, may need some more care with anaesthetic agents used. Nothing more. It seems you have had a pre-op check up and discussion with both your Surgeon and your Anaesthesiologist. I would suggest going ahead with their recommendations. All the best !

Camille Cash, MD · Answer

As you have discussed the situation with both your surgeon and your anesthesiologist you should be fine to proceed as planned.  Be sure that your surgeon is board certified and that your procedure will be performed in an accredited facility for your safety.

Mats Hagstrom, MD (license on probation) · Answer

If you’ve been cleared by the anesthesiologist, then you should be good to go. If you have questions about your upcoming procedure, then I suggest you address those to your operating surgeon.
Best,
Mats Hagstrom, MD

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