An Unusual Cause of Recurrent Laryngeal Nerve Monitoring Failure during Parathyroidectomy

Intraoperative monitoring of the recurrent laryngeal nerve (RLN) during surgical dissection allows for real time identification and assessment of nerve function integrity. Since neuromuscular blockade interferes with electromyography, long-acting muscle relaxants cannot be used during anesthesia. We report a patient in whom monitoring of the RLN was unsuccessful because of prolonged muscle paralysis following the administration of succinylcholine, presumably due to a pseudocholinesterase deficiency.