<prompt> A child presents with bladder exstrophy and chronic renal failure. The muscle relaxant of choice to be used during surgery of exstrophy in this child isPancuroniumRocuroniumMivacuriumAtracurium  <response>: Atracurium:- A bisquaternary competitive blocker and shoer acting: reversal is mostly not required. The unique feature of atracurium is inactivation in plasma by spontaneous non- enzymatic degradation Hofmann elimination in addition to that by cholinesterases. Consequently its duration of action is not altered in patients with hepaticrenal insufficiency or hypodynamic circulation. It is the preferred muscle relaxant for liverkidney disease patients as well as for neonates and the elderly. Hypotension may occur due to dose dependent histamine release. Ref:- kd tripathi; pg num:-353,354 