A 30-year-old man is scheduled for a laparoscopic cholecystectomy for biliary colic. He repos a family history of prolonged paralysis during general anesthesia. Which of the following medications should be avoided during his procedure?: (A) Succinylcholine, (B) Vecuronium, (C) Pancuronium, (D) Etomidate
Answer is A. The family history is suggestive of a pseudocholinesterase deficiency which prolongs the effects of succinylcholine, a depolarizing neuromuscular blocking agent, as well as of mivacurium, a non-depolarizing agent. Vecuronium, pancuronium, and cis-atracurium are other non-depolarizing agents that are not affected by this enzyme deficiency. Etomidate is used for rapid sequence induction and is not affected by pseudocholinesterase deficiency; etomidate does block steroid synthesis and has been associated with acute adrenal insufficiency