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Atracurium elimination — FRCA Primary MCQ

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ModeratePharmacologyAtracurium eliminationFRCA Primary

A 61-year-old patient receives atracurium during anaesthesia for emergency laparotomy. She has severe renal impairment and moderate hepatic dysfunction. Which of the following is correct regarding atracurium?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — It depends mainly on renal excretion for termination

Atracurium is degraded by Hofmann elimination and ester hydrolysis, making duration relatively independent of renal and hepatic function. Sugammadex encapsulates aminosteroid agents such as rocuronium and vecuronium, not atracurium. Histamine release can occur, particularly with rapid administration. The clinical pearl is that organ-independent degradation is useful in multi-organ dysfunction.

Reference: RCoA Primary FRCA Syllabus 2026; Peck, Hill & Williams Pharmacology for Anaesthesia