A child presents with bladder exstrophy and chronic renal failure. The muscle relaxant of choice to be used during surgery of exstrophy in this child is

Atracurium:- A bisquaternary competitive blocker and shoer acting: reversal is mostly not required. The unique feature of atracurium is inactivation in plasma by spontaneous non- enzymatic degradation (Hofmann elimination) in addition to that by cholinesterases. Consequently its duration of action is not altered in patients with hepatic/renal insufficiency or hypodynamic circulation. It is the preferred muscle relaxant for liver/kidney disease patients as well as for neonates and the elderly. Hypotension may occur due to dose dependent histamine release. Ref:- kd tripathi; pg num:-353,354