Ho_2025_A.A.Pract_19_e02062

Succinylcholine is widely used in anesthesia for electroconvulsive therapy (ECT). Succinylcholine apnea is a recognized rare complication. A patient's dormant, undiagnosed, genetic pseudocholinesterase deficiency was clinically triggered and unmasked by the combination of long-term rivastigmine therapy and succinylcholine used in ECT, resulting in post-ictal succinylcholine apnea. In subsequent treatments, low-dose rocuronium was successfully used instead. Clinicians providing electroconvulsive therapy should consider potential interactions between cholinesterase-inhibiting drugs and succinylcholine or use alternative neuromuscular blocking drugs.