SummaryPlasma cholinesterase is an enzyme which has importance to the anaesthetist primarily for its rôle in the metabolism of suxamethonium, although other anaesthetic related drugs that this enzyme metabolises are also increasingly important. In this article we review current thoughts on the function, profile and chemistry of plasma cholinesterase. Causes of variations in the activity of the enzyme are described and the basis of genetic variations is explained.

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Vocal cord palsies are caused by high intracranial pressure and normally improve with treatment. Our case report implies that stridor after drainage of a hydrocephalus, in susceptible patients, can be a result of worsening of vocal cord palsies.

Pediatric perioperative mortality is an objective outcome measure of the safety of anesthesia and surgery. Information on pediatric perioperative cardiac arrest is limited in terms of incidence, risk factors, and outcome. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommends hospitals anesthetizing children to collect data on postoperative outcomes. 1 Anecdotally, heterogeneity exists between trusts in record keeping and finding data for reflective practice is challenging. Our APAGBI linkmen survey, "Clinical Capture of Paediatric Perioperative Morbidity and Mortality in the UK," found most respondents (n = 31; 54%) did not know where to access retrospective data on pediatric perioperative cardiac arrests.We developed an initiative to collect prospective data on pediatric perioperative CAs from May 2019 to March 2021. We involved multiple centers to increase case yield of a rare adverse event and expand learning.Twelve hospitals in London registered with local governance approval: 5 specialist pediatric centers and 7 nonspecialist.Perioperative cardiac arrest was defined as "cessation of adequate mechanical cardiac activity requiring CPR (+/-defibrillation) within 24 h of anesthesia." Demographic, comorbidity, anesthesia, cardiac arrest, and outcome data were collected. Patients ≤18 years were included.Critically ill patients having anesthesia for intensive care (ICU) management were excluded. This report contains complete datasets obtained from two institutions, 27 cardiac arrests in total. Incidence per institution was 0.04% and 0.08%. Table 1 shows demographic data and suspected etiology.Most were male patients (n = 19; 70%). Median age was 12 months (7 days -16 years), including 6 infants and 8 neonates (56%). Fourteen cases (52%) were ASA 4; the remainder were ASA 5 (n = 1; 3.7%), ASA 3 (n = 10; 37%), ASA 2 (n = 1; 3.6%), and ASA 1 (n = 1; 3.7%). Most cases were immediate or urgent (n = 16; 59%). Twenty-four cardiac arrests occurred in theater and three postoperatively.Cardiac cases represented 44% (n = 12): 6 in cardiac theater, 5 in the cardiac angiography suite, and 1 in ICU. The remaining cardiac arrests occurred in ENT (4), interventional radiology (IR) (3), general(3), urology (1), oral-maxillofacial (1), gastrointestinal (1), neurosurgical (1), and orthopedic theaters (1). Six were in cardiac patients having noncardiac surgery (NCS). The most common comorbidity was cardiac (n = 17; 63%): congenital heart disease n = 9, cardiomyopathy n = 6, heart block n = 1, and myocarditis n = 1. Other comorbidities were neuromuscular (spinal muscular atrophy and muscular dystrophy), airway (tracheal tumor, laryngeal cleft, and trachea-esophageal fistula), and respiratory (obstructive sleep apnea and asthma).The predominant cardiac arrest rhythm was pulseless electrical activity (PEA) (n = 24; 89%). Adrenaline was given in 23 (85%) cases as per the Advanced Paediatric Life Support (APLS) algorithm.Median cardiac arrest length was 3 min (45 s-18 min). Etiology was hypoxia or airway rela...