Atracurium organ-independent metabolism — FRCA Primary MCQ

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ModeratePharmacologyAtracurium organ-independent metabolismFRCA Primary

A patient with combined renal and hepatic failure requires muscle relaxation for laparotomy. Which neuromuscular blocker is favoured because breakdown is largely organ independent?

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Correct answer: B — Atracurium

Atracurium undergoes Hofmann elimination and ester hydrolysis, making its duration relatively independent of renal and hepatic function. Pancuronium is significantly renally excreted, and vecuronium and rocuronium may be prolonged in organ failure. Mivacurium is metabolised by plasma cholinesterase but is not the usual choice for profound paralysis in this context. Cisatracurium is another useful organ-independent option.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care