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Laryngeal Adductors More Resistant — FRCA Primary MCQ

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HardPharmacology - NeuromuscularLaryngeal Adductors More ResistantFRCA Primary

After a standard intubating dose of rocuronium, adductor-pollicis train-of-four count is zero. Which statement best describes the likely laryngeal state at that time?

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Correct answer: E — Laryngeal adductors may be less blocked because their sensitivity is lower

The best answer is “Laryngeal adductors may be less blocked because their sensitivity is lower”. Laryngeal adductors and diaphragm are relatively resistant to non-depolarising block compared with adductor pollicis. Thus a profoundly blocked thumb does not establish an identical laryngeal effect, while during recovery the more resistant respiratory muscles tend to recover earlier. Cranial innervation does not make laryngeal muscle immune to neuromuscular blockers.

Reference: RCoA, Primary FRCA syllabus: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf; Onset and duration of rocuronium and suxamethonium at laryngeal adductors and adductor pollicis: https://pubmed.ncbi.nlm.nih.gov/7978469/