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Hyperkalaemia Induction Agent Choice — FRCA Final MCQ

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ModerateGeneral AnaesthesiaHyperkalaemia Induction Agent ChoiceFRCA Final

A 60-year-old ESRF patient on haemodialysis has K+ 5.8 mmol/L morning of surgery for parathyroidectomy. Which induction strategy minimises hyperkalaemic arrest risk?

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Correct answer: C — Modified RSI with rocuronium and propofol

K+ 5.8: suxamethonium absolutely contraindicated (causes ~0.5-1.0 mmol/L rise via skeletal muscle depolarisation). Modified RSI with rocuronium 1.2 mg/kg provides rapid intubating conditions without hyperkalaemic risk. Sugammadex must be immediately available.

Reference: RCOA – 2023 – Perioperative management of renal disease