Critical Care Medicine-Neurologic Disorders>>>>>Analgesia, Sedation and Neuromuscular Blockade
Question 6#

Which of the following neuromuscular blocking drugs do not depend on hepatic or renal function for clearance?

A. Rocuronium
B. Cisatracurium
C. Vecuronium
D. Pancuronium

Correct Answer is B

Comment:

Correct Answer: B

Cisatracurium (and certain other benzylisoquinolinium derivatives such as atracurium and mivacurium) does not depend on renal or hepatic function for its metabolism. More than 75% of cisatracurium undergoes spontaneous degradation via Hofmann elimination. Atracurium undergoes both Hofmann degradation and ester hydrolysis by nonspecific esterases. However, alterations in physiologic pH or temperature can affect the rate of Hofmann elimination. On the other hand, aminosteroid compounds (vecuronium, rocuronium, pancuronium, etc) have hepatic and/ or renal mechanisms of elimination.

Reference:

1. Miller RD. Miller’s Anesthesia. 8th ed.; San Diego: Churchill Livingstone; 2015 :Chap 29