A patient with end-stage renal disease on haemodialysis requires anaesthesia. Which muscle relaxant should be AVOIDED due to the accumulation of active metabolites?
- A Atracurium
- B Cisatracurium
- C Pancuronium ✓
- D Rocuronium with sugammadex reversal
Correct answer: C. Pancuronium
Explanation
Pancuronium is predominantly eliminated by the kidneys (70–80% unchanged), and its active 3-desacetyl metabolite also accumulates in renal failure, leading to prolonged neuromuscular blockade. Atracurium and cisatracurium undergo organ-independent Hofmann elimination (spontaneous chemical degradation at physiological pH and temperature) and ester hydrolysis, making them the preferred agents in renal failure. Rocuronium is hepatically eliminated; its use is acceptable in renal disease if sugammadex is available for reversal.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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