Final answer:
Adjustment of medication dosing is crucial in severe liver failure. Succinylcholine may require dose reduction, cisatracurium does not need adjustment, and mivacurium's metabolism will likely be affected contrary to the suggestion in option C.
Step-by-step explanation:
In the context of severe liver failure, medication dosing requires careful consideration due to the potential alteration in drug metabolism. Specifically, options A, B, and C are referencing different neuromuscular blocking agents and their dosing in the context of liver impairment.
Succinylcholine (sux), mentioned in option A, is normally rapidly metabolized by plasma cholinesterase. In severe liver failure, plasma cholinesterase levels may be reduced, potentially prolonging the action of succinylcholine, thus necessitating a dose reduction.
Option B suggests that no adjustment to the dose of cisatracurium is needed in the setting of liver failure. This can be explained by the fact that cisatracurium undergoes Hofmann elimination, a process independent of liver enzymes, hence why the dose does not need to be adjusted in liver failure.
For mivacurium, its metabolism can be altered in liver failure as it is also metabolized by plasma cholinesterase, similar to succinylcholine. Therefore, option C, suggesting that mivacurium's metabolism will be unchanged, is incorrect. It should be anticipated that mivacurium's metabolism would indeed be affected.