A 58-year-old with stage 3b CKD (eGFR 28 mL/min) requires emergency laparotomy. Which muscle relaxant is the preferred choice to minimise risk of prolonged neuromuscular blockade?
- A Pancuronium
- B Vecuronium
- C Atracurium ✓
- D Rocuronium at standard intubating dose
Correct answer: C. Atracurium
Explanation
Atracurium (and cisatracurium) undergoes Hofmann elimination (spontaneous pH- and temperature-dependent degradation) and ester hydrolysis, making it entirely independent of renal or hepatic excretion. Its laudanosine metabolite can cause CNS stimulation but accumulation is clinically significant only in prolonged ICU infusions. Pancuronium has 80% renal excretion; vecuronium 30–40% renal excretion; both accumulate and prolong blockade in severe CKD. Rocuronium is primarily biliary but also has renal component and prolonged duration in renal failure.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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