Muscle relaxants: reversal in severe asthma: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Muscle relaxants: reversal in severe asthma

Sample item

A man with poorly controlled asthma and a resting heart rate of 48 per minute needs reversal of rocuronium at the end of surgery. Which reversal agent avoids muscarinic effects such as bronchoconstriction and bradycardia?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Sugammadex

Sugammadex encapsulates rocuronium directly and has no action on cholinesterase, so no antimuscarinic cover is needed. Anticholinesterases raise acetylcholine at muscarinic sites and can provoke bronchospasm, secretions and bradycardia even when an antimuscarinic is given.

Option by option

  • A. Neostigmine with glycopyrrolate

    Neostigmine increases muscarinic stimulation, which the antimuscarinic only partly covers.

  • B. Edrophonium with atropine

    Edrophonium raises acetylcholine and needs atropine, which causes tachycardia and thick secretions.

  • C. Pyridostigmine with atropine

    Pyridostigmine is also an anticholinesterase with the same muscarinic effects.

  • D. Sugammadex (correct)

    Correct. It acts by chemical encapsulation, not by raising acetylcholine, so muscarinic effects are avoided.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Sugammadex. Sugammadex encapsulates rocuronium directly and has no action on cholinesterase, so no antimuscarinic cover is needed.

Why is "Neostigmine with glycopyrrolate" not the answer?

Neostigmine increases muscarinic stimulation, which the antimuscarinic only partly covers.

Why is "Edrophonium with atropine" not the answer?

Edrophonium raises acetylcholine and needs atropine, which causes tachycardia and thick secretions.

Why is "Pyridostigmine with atropine" not the answer?

Pyridostigmine is also an anticholinesterase with the same muscarinic effects.

What concept does this question test?

It tests Muscle relaxants: reversal in severe asthma in Anaesthesia. Anticholinesterases raise acetylcholine at muscarinic sites and can provoke bronchospasm, secretions and bradycardia even when an antimuscarinic is given.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Muscle relaxants: reversal in severe asthma?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.