A 58-year-old woman undergoing elective open cholecystectomy receives a non-depolarising muscle relaxant. Which is the most common non-depolarising muscle relaxant used in Indian operating theatres for maintenance of anaesthesia?

Explanation

## Most Common Non-depolarising Muscle Relaxant in India **Key Point:** Vecuronium is the most frequently used non-depolarising muscle relaxant for maintenance of anaesthesia in Indian operating theatres due to its favourable pharmacokinetics, intermediate duration, and cost-effectiveness. ### Why Vecuronium is Most Common 1. **Onset**: 2–3 minutes (suitable for intubation and maintenance) 2. **Duration**: 25–40 minutes (intermediate — allows flexibility in operating time) 3. **Metabolism**: Hepatic (organ-dependent) with Hofmann elimination (minimal renal dependence) 4. **Cost**: Affordable compared to rocuronium and cisatracurium 5. **Availability**: Widely available in Indian hospitals 6. **Clinical profile**: No histamine release, no active metabolites ### Comparison of Non-depolarising Agents | Agent | Onset (min) | Duration (min) | Metabolism | Cost | Frequency in India | | --- | --- | --- | --- | --- | --- | | **Vecuronium** | 2–3 | 25–40 | Hepatic + Hofmann | Low | **Most common** | | Rocuronium | 1–1.5 | 30–40 | Hepatic | High | Second choice | | Atracurium | 3–5 | 30–45 | Ester hydrolysis + Hofmann | Moderate | Declining use | | Cisatracurium | 2–3 | 40–60 | Ester hydrolysis + Hofmann | High | Limited use | **High-Yield:** Vecuronium is the MOST COMMON non-depolarising agent in India. Rocuronium is increasingly used for RSI (faster onset), but vecuronium remains the workhorse for maintenance due to cost and availability. ### Vecuronium: Clinical Advantages - **Intermediate duration** → suits most surgical procedures (1–3 hours) - **Hofmann elimination** → metabolised even in renal/hepatic failure (though slower) - **No histamine release** → safe in asthmatics, anaphylaxis-prone patients - **No active metabolites** → no cumulative effect - **Reversible** with neostigmine + glycopyrrolate (anticholinergic) **Mnemonic:** **VENOM** = **V**ecuronium is **E**very **N**ursing **O**T's **M**ost common choice (India) **Clinical Pearl:** While rocuronium has a faster onset (1–1.5 min) making it ideal for RSI, vecuronium's intermediate duration and lower cost make it the standard choice for maintenance in Indian practice. Rocuronium is reserved for situations requiring rapid intubation.