Pitfalls of electromyography (EMG) in parathyroidectomy: a case report of unrecognized pseudocholinesterase deficiency

If the EMG signal is missing in the early phase or if the EMG amplitude increases over time, suspicion for PChE deficiency should be high. Reviewing the literature, we recognized that there are no comprehensive checklists for EMG signals during parathyroid surgery. Based on our case report, we recommend establishing evidence-based anesthesia checklists at institutions that perform EMG monitoring since false negative results can have safety and economic implications.