A patient with renal failure requires neuromuscular blockade for a 3-hour abdominal procedure. Which agent is MOST appropriate given its organ-independent elimination?
- A Vecuronium
- B Rocuronium
- C Cisatracurium ✓
- D Pancuronium
Correct answer: C. Cisatracurium
Explanation
Cisatracurium undergoes Hofmann elimination — a spontaneous, non-enzymatic, pH- and temperature-dependent degradation that is completely organ-independent. Its metabolites (laudanosine and acrylate) are inactive at clinical concentrations. Pancuronium and vecuronium depend significantly on renal excretion and show prolonged action in renal failure. Rocuronium is primarily hepatically eliminated but accumulation can occur with severe renal dysfunction. Atracurium also undergoes Hofmann elimination but produces more laudanosine than cisatracurium.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.