In patients where succinylcholine should be avoided, what alternative is used?

• A. Propofol is used as an alternative neuromuscular blocker.
• B. Rocuronium is used as a nondepolarizing alternative.
• C. Atracurium is used in all cases.
• D. Succinylcholine remains the preferred agent in these patients.

Answer: (B)

If succinylcholine must be avoided, the goal is a rapid, reliable neuromuscular block to facilitate intubation without the risks linked to a depolarizing agent. Rocuronium, a nondepolarizing neuromuscular blocker, is preferred because at a high dose (about 1.2 mg/kg) it produces onset of paralysis in roughly a minute, giving intubating conditions that closely match those of succinylcholine for rapid sequence induction. It also avoids risks like hyperkalemia in denervated or burned patients and the malignant hyperthermia associated with succinylcholine. Plus, if needed, its effects can be rapidly reversed with sugammadex.

Propofol is an induction agent, not a neuromuscular blocker, so it cannot substitute for paralysis. Atracurium can be used as a nondepolarizing blocker but has a slower onset and is not ideal for rapid sequence scenarios. Succinylcholine remains contraindicated in these patients, so it isn’t the preferred choice.