A 6 year old boy is scheduled for examination of the eye under anaesthesia. The father informs that for the past 6 months the child has been developing progressive weakness of both legs. His elder sibling had died at age 14 years. Which drug would you definitely avoid during anaesthetic management?

Question

Image below highlights jugular foramen. Which of the following structures do not pass through the marked structure “A”?

Answer 1

The child has slowly worsening weakness in both legs, and his older sibling died at just 14 years old. This pattern points toward an undiagnosed muscular dystrophy, and the question wants the drug that must be kept away from him during anaesthesia.

Succinylcholine: in muscle disease, acetylcholine receptors spread across the entire muscle membrane instead of staying at the neuromuscular junction. Succinylcholine opens all of them at once, flooding the blood with potassium fast enough to stop the heart, and it can also set off a malignant hyperthermia like reaction. This drug carries a real risk of sudden death here and must not be given.
Thiopentone: a routine induction agent with no special danger tied to muscle disease, so it stays safe to use.
Nitrous oxide: an inhaled anaesthetic gas that plays no part in the potassium surge problem, so there is no reason to withhold it.
Vecuronium: a non depolarising relaxant. It may act longer than usual in a myopathic child, but it does not trigger the dangerous potassium surge that succinylcholine does, so it can be used carefully.

Given the strong suspicion of muscular dystrophy from the history, succinylcholine is the one drug that must be avoided completely.

Let's summarize:

Progressive leg weakness plus an early sibling death is a red flag for muscular dystrophy, even without lab confirmation.
Succinylcholine can cause fatal hyperkalemia in such patients and must never be given.

The drug to definitely avoid is succinylcholine.

Answer 2

The child has slowly worsening weakness in both legs, and his older sibling died at just 14 years old. This pattern points toward an undiagnosed muscular dystrophy, and the question wants the drug that must be kept away from him during anaesthesia.

Succinylcholine: in muscle disease, acetylcholine receptors spread across the entire muscle membrane instead of staying at the neuromuscular junction. Succinylcholine opens all of them at once, flooding the blood with potassium fast enough to stop the heart, and it can also set off a malignant hyperthermia like reaction. This drug carries a real risk of sudden death here and must not be given.
Thiopentone: a routine induction agent with no special danger tied to muscle disease, so it stays safe to use.
Nitrous oxide: an inhaled anaesthetic gas that plays no part in the potassium surge problem, so there is no reason to withhold it.
Vecuronium: a non depolarising relaxant. It may act longer than usual in a myopathic child, but it does not trigger the dangerous potassium surge that succinylcholine does, so it can be used carefully.

Given the strong suspicion of muscular dystrophy from the history, succinylcholine is the one drug that must be avoided completely.

Let's summarize:

Progressive leg weakness plus an early sibling death is a red flag for muscular dystrophy, even without lab confirmation.
Succinylcholine can cause fatal hyperkalemia in such patients and must never be given.

The drug to definitely avoid is succinylcholine.

A 6 year old boy is scheduled for examination of the eye under anaesthesia. The father informs that for the past 6 months the child has been developing progressive weakness of both legs. His elder sibling had died at age 14 years. Which drug would you definitely avoid during anaesthetic management?

Show Hint

The Correct Option is A

Solution and Explanation

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