A patient with end-stage renal disease (eGFR 8 mL/min) on haemodialysis requires emergency appendicectomy. Which neuromuscular blocking agent is preferred for RSI to avoid prolonged paralysis?

• A Vecuronium 0.1 mg/kg
• B Atracurium 0.5 mg/kg
• C Pancuronium 0.1 mg/kg
• D Rocuronium 1.2 mg/kg with sugammadex reversal available ✓

Explanation

Succinylcholine is relatively contraindicated in ESRD if serum potassium is ≥5.5 mEq/L due to risk of hyperkalaemia-induced cardiac arrest. Rocuronium 1.2 mg/kg provides RSI-quality intubating conditions in 60 seconds and can be rapidly reversed with sugammadex 16 mg/kg even in renal failure, since sugammadex-rocuronium complex is excreted renally but is safe for single use. Vecuronium and pancuronium rely heavily on renal excretion and accumulate in ESRD causing prolonged block. Atracurium undergoes Hofmann elimination independent of organ function but is not ideal for RSI at standard doses.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.