Which of the following can be used in a patient with hepatic as well as renal failure?
Ans. a (Atracurium) (Ref. KDT 5th ed., 314)The unique feature of atracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofmann elimination) in addition to that by cholinesterases. Consequently its duration of action is not altered in patients with hepatic/renal insufficiency or hypodynamic circulation. It is the preferred muscle relaxant for such patients as well as for neonates and the elderly. Hypotension may occur due to histamine release.Cisatracurium, R-Cis enantiomer of atracurium is nearly 4 times more potent, slower in onset, but similar in duration of action. Like atracurium it undergoes Hofmann elimination, but in contrast it is not hydrolysed by plasma cholinesterase. Most importantly, it does not provoke histamine release.Muscle Relaxants (MR)Causes histamine releaseVagolytic propertyContraindicated in renal failureDose to be reduced in Renal failureContraindicated in Biliary obstructioniiiiiD-tubocurarineDoxacuriumAtracuriumMivacuriumPancuroniumVecuroniumRocuroniumGallamineGallamineMetocurineVecuroniumD-tubocurarePancuroniumDoxacuriumVecuroniumRocuronium# Muscle relaxant of choice for rapid sequence intubation is Rocuronium. The rapid onset and intermediate duration of action makes this agent a potential replacement for succinylcholine in conditions where rapid tracheal intubation is indicated.# Vecuronium releases no histamine and has no cardiovascular action except it can cause tachycardia is individuals with hyperthyroid conditions who are sensitized to catecholamines.# Pancuronium does not release very much histamine and it has little effect on the cardiovascular system unless it is administered rapidly. If given rapidly it can increase blood pressure.
Atracurium
Vecuronium
Pancuronium
Mivacurium
Muscle Relaxant