Prolonged apnea following electroconvulsive therapy in a patient with attempted organophosphate suicide: a case report

Organophosphate poisoning is a frequent used method of suicide attempt in Turkey. Organophosphates are irreversibly bound to cholinesterase enzyme, causing deactivation of the enzyme. As a result the of inhibition of plasma cholinesterase, increased sensitivity to drugs hydrolyzed by this enzyme can occur, e.g. neuromuscular blockers such as succinylcholine and mivacurium may be affected. Muscle paralysis continues if the action of these neuromuscular drugs is not terminated. In this case report we present a case of a 6-hour period of apnea and paralysis following anesthesia with a muscle relaxant for electroconvulsive therapy in a bipolar disorder patient with mixed episode who attempted suicide with organophosphate ten days prior. ÖZET Organofosfat içeren tar›m ilaçlar›yla intihar giri.imi ülkemizde s›krastlanan intihar yöntemlerinden birisidir. Organofosfatlar asetil-kolinesteraz enzimine dönü.ümsüz ba¤lanarak onu inaktif halegetirirler. Plazma asetilkolinesteraz›n›n inhibe edilmesi ile, bu en-zim taraf›ndan y›k›lan süksinilkolin ve mivaküryum gibi kas gev.e-ticilerin etkileri artmaktad›r. Bu kas gev.eticilerin etkileri sonlan-d›r›lamazsa tüm kaslarda paralizi geli.ir. Bu olgu sunumunda ongün öncesinde intihar amac›yla organofosfat alm›., iki uçlu duy-gudurum bozuklu¤u-mikst epizod tan›s› konulan bir olgunun, ge-nel anestezi alt›nda yap›lan kas gev.eticili elektrokonvulsif tedavisonras›nda 6 saat devam eden apne tablosu sunularak; organo-fosfat zehirlenmesi olan ki.ilerde elektrokonvulsif tedavi uygula-mas› tart›.›lm›.t›r