I diagnosed my first pseudocholinesterase deficiency as a CA-1 (for non-doctors: second-year resident, patient was still paralyzed after a long case from a drug that usually lasts ~5 minutes, had to send him to ICU on ventilator until it finally broke down from all the other enzymes in the body). Had to be an attending for ~10 years before I got a malignant hyperthermia case. Do not want to repeat either of those.
No. Surprises. Ever. Unless it's ROSC (return of spontaneous circulation, aka we succeeded) in a code.
That's interesting. I never encountered either a pseudocholinesterase deficiency or MH during my 38 years of residency/attending/private practice.
However — in my first year of residency, during my rotation at the VA, while performing my first brachial plexus block, I unknowingly injected lidocaine into the axillary artery: as the patient began seizing, the attending calmly said "Joe, take out the needle, I'm going to give him some diazepam." Worked!
Never had another intravascular injection (that became symptomatic) doing a regional block.
One of my attendings during residency was Kenyan. In the bush, pediatric anesthesia was lido until they seized. At that point, you knew they could not feel anything.
No. Surprises. Ever. Unless it's ROSC (return of spontaneous circulation, aka we succeeded) in a code.