This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Anesthesia, Subject name: Pharmacology
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 is 
Select and explain. 
A. Pancuronium, B. Rocuronium, C. Mivacurium, D. Atracurium
D: Atracurium
Answer: D: Atracurium 
Explanation: 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 hepatic/renal insufficiency or hypodynamic circulation. It is the preferred muscle relaxant for liver/kidney 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