Cisatracurium is preferred over atracurium in patients with hepatic and renal failure. The primary reason is:

• A Cisatracurium does not produce laudanosine, avoiding seizure risk
• B Cisatracurium undergoes faster plasma ester hydrolysis than atracurium
• C Cisatracurium has a steroid nucleus that is conjugated in extrahepatic tissues
• D Cisatracurium is almost entirely eliminated by Hofmann degradation, independent of organ function ✓

Explanation

Cisatracurium (a single stereoisomer of atracurium) undergoes Hofmann elimination — spontaneous, temperature- and pH-dependent degradation at physiological conditions — for approximately 77% of its elimination, with ester hydrolysis accounting for the remainder. Unlike atracurium, which relies more on ester hydrolysis and produces more laudanosine (a CNS stimulant that can cause seizures at high concentrations), cisatracurium's organ-independent elimination makes it ideal in multi-organ failure. Both produce laudanosine, but cisatracurium produces substantially less per equipotent dose.

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

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Written and medically reviewed by the StethoPrep medical team.