A patient with end-stage renal disease on haemodialysis is scheduled for arteriovenous fistula revision under regional anaesthesia. Which muscle relaxant is MOST appropriate if general anaesthesia becomes necessary?

• A Rocuronium
• B Vecuronium
• C Pancuronium
• D Atracurium ✓

Explanation

Atracurium (and its isomer cisatracurium) undergoes Hofmann elimination and ester hydrolysis independent of renal or hepatic function, making it the relaxant of choice in renal failure. Rocuronium and vecuronium have significant renal excretion and accumulate in ESRD. Pancuronium is almost entirely renally excreted and is contraindicated. Laudanosine, a metabolite of atracurium, can accumulate but is clinically insignificant at standard doses.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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