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In one of the first descriptions of the genetic basis of variability in drug response, professor Werner Kalow reported that paralysis after receiving the neuromuscular blocker succinylcholine was due to a genetically based deficiency in pseudocholinesterase. Of the 171 suspicious deaths they identified, 20 bodies were exhumed and examined for traces of two chemicals - Succinylcholine chloride and Pavulon - injected by Saldivar. Upon exposure to caffeine, succinylcholine (a muscle relaxant), and certain inhalational anesthetics, both the ryanodine receptor's threshold for calcium release and the membrane polarization are reduced,[1] setting off the cascade of events that underlie the serious clinical presentation. |
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