BCHE and respiratory failure: A high frequency (∼4,000-fold higher than Caucasian populations) of homozygous silent mutations in the butyrylcholinesterase gene (BChE; responsible for apnea, respiratory failure, and prolonged paralysis after succinylcholine or mivacurium treatment) has been reported in the Arya Vysya community in India (Liao, 2007).