Which two neuromuscular blocking agents undergo metabolism through Hofmann elimination?

The correct choice highlights the unique characteristic of atracurium and cisatracurium, both of which undergo metabolism via Hofmann elimination. This metabolic process is significant because it allows for the breakdown of these neuromuscular blocking agents in a manner that is independent of the liver and kidneys, making them particularly useful in patients who may have compromised renal or hepatic function.

Hofmann elimination is a reaction that occurs at physiological pH and temperature, where the drug is converted into an active metabolite and a further breakdown product, ultimately leading to the inactivation of the neuromuscular blockade. This property allows atracurium and cisatracurium to have a shorter duration of action that does not rely on conventional metabolic pathways, ensuring that they can be administered safely even in varying patient conditions.

In contrast, other neuromuscular blockers listed do not primarily utilize Hofmann elimination. For example, rocuronium and vecuronium are mainly metabolized by hepatic pathways and are not affected by the same mechanism of elimination, making them less suited for patients with liver dysfunction. Succinylcholine, while it has rapid onset and offset characteristics, is metabolized by plasma cholinesterase rather than through Hofmann elimination.