A 28-year-old woman with myasthenia gravis requires a muscle relaxant for a brief surgical procedure. Which agent is the SAFEST choice given her condition?
- A Succinylcholine at standard dose
- B Atracurium at substantially reduced dose ✓
- C Vecuronium at standard dose
- D Mivacurium at standard dose
Correct answer: B. Atracurium at substantially reduced dose
Explanation
Myasthenia gravis patients are exquisitely sensitive to non-depolarising blockers because the disease itself reduces functional acetylcholine receptors at the neuromuscular junction. Atracurium at a substantially reduced dose (approximately one-tenth of the usual dose) can be used with careful monitoring and reversal. Succinylcholine may produce a prolonged phase II block and unpredictable response. Standard doses of vecuronium or mivacurium carry high risk of prolonged paralysis.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.