A 4-year-old on echothiophate iodide drops for accommodative esotropia is scheduled for elective strabismus surgery. The anesthetist must be warned beforehand chiefly because echothiophate:
- A Inhibits plasma cholinesterase, prolonging apnea after succinylcholine ✓
- B Causes severe intraoperative bradycardia requiring atropine premedication only
- C Potentiates volatile anesthetic hepatotoxicity in children
- D Produces resistant hypertension with ketamine induction
Correct answer: A. Inhibits plasma cholinesterase, prolonging apnea after succinylcholine
Explanation
Echothiophate is an irreversible organophosphate anticholinesterase. Systemic absorption suppresses plasma pseudocholinesterase for weeks, so succinylcholine given for intubation is hydrolyzed slowly and the child may develop prolonged apnea requiring ventilatory support. This interaction is a classic anesthesia warning. Bradycardia from vagal tone is a general pediatric concern but is not the specific reason this drug mandates advance notice, and no important interaction exists with volatile agents or ketamine.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
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