Atracurium can cause hypotension and flushing in some patients. This side effect is attributed to:

• A Vagolytic action causing tachycardia and increased cardiac output
• B Histamine release from mast cell degranulation ✓
• C Direct myocardial depression similar to volatile anesthetics
• D Activation of nicotinic receptors in autonomic ganglia

Explanation

Atracurium causes dose-dependent histamine release from mast cells, leading to hypotension, flushing, and bronchospasm. Cisatracurium, a stereoisomer of atracurium, does not cause significant histamine release at clinical doses. Pancuronium causes tachycardia via vagolytic action, not histamine release. Rapid injection of atracurium worsens histamine-mediated effects.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.