A 6 year old boy taken for ophthalmic examination under anaesthesia. His father told that he has lower limb weakness & his elder brother died at 14 years of age. Which anaethetic drug has to be avoided-
## **Core Concept**
The question hints at a genetic condition affecting muscle strength, given the history of lower limb weakness in the child and a sibling's death at a young age. This scenario suggests a condition like Duchenne Muscular Dystrophy (DMD), a genetic disorder characterized by progressive muscle degeneration and weakness.
## **Why the Correct Answer is Right**
The correct answer, , refers to **Succinylcholine**. Succinylcholine is a depolarizing muscle relaxant commonly used in anesthesia to facilitate endotracheal intubation and to provide muscle relaxation during surgery. However, in patients with muscular dystrophies like DMD, succinylcholine can cause **severe hyperkalemia**, leading to cardiac arrest. This is because the muscle damage in DMD leads to the upregulation of nicotinic acetylcholine receptors at the muscle membrane, making the muscles more susceptible to the depolarizing effects of succinylcholine.
## **Why Each Wrong Option is Incorrect**
- **Option A:** refers to a non-depolarizing muscle relaxant. Non-depolarizing agents do not typically cause the same level of concern in muscular dystrophy patients as succinylcholine.
- **Option B:** is a volatile anesthetic. While volatile anesthetics can be used cautiously in patients with muscular dystrophy, they are not specifically contraindicated like succinylcholine.
- **Option D:** is an inhalational anesthetic agent. Like option B, it is not specifically contraindicated in patients suspected to have muscular dystrophy.
## **Clinical Pearl / High-Yield Fact**
In patients with suspected or known muscular dystrophy, it is crucial to avoid **succinylcholine** due to the risk of fatal hyperkalemia. Additionally, **malignant hyperthermia** is a concern with certain volatile anesthetics in patients with muscular dystrophy. A thorough preoperative evaluation for signs of muscle disease is essential.
## **Correct Answer: C. Succinylcholine**