Walsh_2025_Cureus_17_e98727

Pseudocholinesterase deficiency is a rare disorder of the enzyme butyrylcholinesterase that can lead to delayed emergence following exposure to depolarizing neuromuscular blocking agents. We report the case of a 19-year-old male who underwent elective tonsillectomy and experienced prolonged postoperative paralysis, suspected to be due to pseudocholinesterase deficiency. The patient had no significant past medical history or family history of the condition. This report highlights the clinical implications of pseudocholinesterase deficiency and discusses strategies for perioperative management.