Suxamethonium apnoea in a pregnant patient undergoing emergency lower segment Caesarean section under general anaesthesia

We report a well-described but rare occurrence of suxamethonium apnoea, also known as Phase II block. A 16-year-old Burmese primigravida at 38 weeks and 4 days’ gestation was scheduled for an emergency lower segment Caesarean section due to poor progress in labour. Her antenatal course had been uneventful, and she had no significant medical history, allergies, or history of prior surgery. General anaesthesia was chosen due to her age and clinical circumstances. Rapid sequence induction was performed using intravenous propofol and suxamethonium. Muscle relaxation was subsequently maintained with atracurium. At the end of an uneventful surgery, reversal with neostigmine and atropine was administered upon observing spontaneous breathing effort. However, 30 minutes later, the patient still exhibited poor respiratory effort with persistent hypercapnia and poor motor strength. The patient was subsequently sedated with propofol and transferred to the Intensive Care Unit for ventilatory support and neuromuscular monitoring. She was extubated and transferred to the general ward the following morning.