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What is Hoffman's elimination is seen with: and explain in detail?
Ans: A (Atracurium) Ref: Mi Her text hook of Anaesthesia. 6th edition.ExplanationAtracuriumAtracurium and eisatracuriuni (stereoisomer of atracurium) are the only two drugs metabolized by Hoffman eliminationAtracurium is a short acting non-depolarizing neuromuscular blockerAtracurium is metabolized by Non-specific esterases & Hoffman's elimination, independent of renal and hepatic metabolismHence Drug of choice in hepatic and renal failureHoffman's eliminationIt is the spontaneous non-enzymatic chemical breakdown at physiologic PH and temperatureHoffman's elimination of atracurium gives a metabolite called laudanosine which can precipitate seizuresIt triggers the release of histamine leading to hypotension, tachycardia & bronchospasmDosage - 0.5mg/kg (See the following table) AtracuriumCisatracurium(stereoisomer of Atracurium)PotencyLessMoreNon specific ester hydrolysisYesNoHoffman eliminationYesYesMetabolite - LaudanosheQuantity producedMoreLessCNS toxicity seizuresYesNoHistamine releaseYesNo