This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Anaesthesia, Subject name: Pharmacology
Muscle relaxant of choice in a patient with serum bilirubin of 6 mg/dl and serum creatinine of 4.5 mg/dl is: 
Select and explain. 
A. Vecuronium, B. Atracurium, C. Pancuronium, D. Mivacurium
B: Atracurium
Answer: B: Atracurium 
Explanation: Ans. (B) Atracurium(Ref: KDT 8th/e p380)Atracurium is eliminated by Hoffman's elimination. It means it neither require liver for metabolism, nor kidney for excretion. Its molecules spontaneously rearrange to make it inactive. Thus it is safest muscle relaxant in a patient with liver and kidney disease.