A 55-year-old patient with end-stage renal disease requires neuromuscular blockade for a 2-hour procedure. Which agent is most appropriate given its organ-independent elimination by Hofmann degradation?
- A Vecuronium
- B Pancuronium
- C Atracurium ✓
- D Rocuronium
Correct answer: C. Atracurium
Explanation
Atracurium undergoes Hofmann degradation (pH- and temperature-dependent spontaneous breakdown) and ester hydrolysis, making it independent of renal and hepatic function. Vecuronium, rocuronium, and pancuronium rely significantly on hepatic metabolism and biliary or renal excretion, leading to prolonged action in organ failure. Cisatracurium also undergoes Hofmann degradation and is another suitable choice.
Reference: Miller's Anesthesia, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.