Muscle relaxant not to be used in liver failure:
Among muscle relaxants metabolism in liver occurs with pancuronium (10-20%), vecuronium (20%) and biliary excretion occurs with rocuronium (40%). vecuronium (30-40%) and pancuronium (10%). So these agents should be avoided in hepatic diseases. Suxamethonium effect is prolonged in only in severe liver failure due to decreased pseudocholinesterase, so is usually acceptable in mild to moderate cases.
d- Tubocurare
Pancuronium
Suxamethonium
Decamethonium