Which class of agents is used as an alternative when depolarizing agents are avoided?

• A. Nondepolarizing agents such as rocuronium are used as alternatives when depolarizing agents are avoided.
• B. Succinylcholine is always used.
• C. Nondepolarizing agents are never used.
• D. Propofol is a neuromuscular blocker.

Answer: (A)

When a depolarizing neuromuscular blocker is avoided, clinicians turn to nondepolarizing neuromuscular blocking agents. These drugs work by competitively blocking acetylcholine receptors at the neuromuscular junction, preventing stimulation of the muscle without causing the initial depolarization that depolarizing agents produce. A common example is rocuronium, a nondepolarizing agent used to achieve paralysis for airway management. Its onset can be rapid enough for rapid sequence intubation at higher doses, and its effects can be reversed with appropriate agents if needed.

The other statements don’t fit because succinylcholine is a depolarizing blocker and is not used when depolarizing agents are avoided; nondepolarizing agents are indeed used in such situations; and propofol is an anesthetic agent, not a neuromuscular blocker.