Epidural and Cholinesterase Deficiency?

Question

I have pseudocholinesterase deficiency (BCHE gene), but my wife does not. My wife may need/strongly desire an epidural for our next child. Is this safe for a fetus which may possibly have the same condition as me? If not, then what is a safe alternative? \n\nOne specific drug I'm concerned about is bupivacine, which, I read affects me more powerfully than the typical person. \n\nI have read the information from 23 and me about this condition. I have read "Pseudocholinesterase Deficiency: A Comprehensive Review of Genetic, Acquired and Drug Influences". None of the articles I have read with pregnancy being mentioning dealt with this condition except to mention that pregnancy often leads to a acquired deficiency.

Answer 1

Hello,

I believe question actually requires two answers; one pathophysiology & one pharmacology.

Pathophysiology

Inherited pseudocholinesterase deficiency is an autosomal recessive abnormality in which this would mean you are homozygous for the BCHE gene abnormality ( one defective gene from your mother & one defective gene from your father). Inherited pseudocholinesterase deficiency in the baby would require another defective gene from your wife and unless she was heterozygous for pseudocholinesterase deficiency, the baby would have at least one fully functional BCHE gene expressed ( i.e. not have the abnormality).

Pharmacology

Pseudocholinesterase deficiency impacts the metabolism of several drugs that are relevant to anesthesia, such as ester local anesthetics and neuromuscular blocking agents (succinylcholine & mivacurium). Although NMB agents do not cross the placental barrier, local anesthetics do cross and could reach fetal circulation. With that said, you mention bupivacaine in your question, which is not an ester local anesthetic ( bupivacaine is an amide local anesthetic) and is actually metabolised in the liver and not in the plasma by pseudocholinesterase.

Hope this helps to answer your question(s).

Kind regards

Ed W