NMB monitoring

Question 1

what ratio can patient lift head for 3 seconds, open eyes and stick out tongue?

Answer 1

0.6

Question 2

patient can lift head and arm?

Answer 2

0.4 TOF ratio

Question 3

patient can cough, lift head for 5 seconds, but grip strength weak

Answer 3

0.75

Question 4

vital capacity and inspiratory capacity normal?

Answer 4

0.8

Question 5

what TOF ratio is adequate recovery of neuromuscular function

Answer 5

0.75

Question 6

what tests give you 75-80% of receptors blocked?

Answer 6

twitch height, tetanic stim (30hz), vital capacity, TOF

Question 7

What test gives you 80% of receptors occupied?

Answer 7

TV

Question 8

What test gives you 50% of receptors occupied?

Answer 8

tetanic stim at 100hz and inspiratory force

Question 9

what test tells you 33% percent of receptors are occupied?

Answer 9

head lift 5 sec

Question 10

if using sux for intubation, when will normal twitches return?

Answer 10

4-8 minutes

Question 11

what muscles have the fastest ONSET time?

Answer 11

diaphragn, vocal cords, larynx

Question 12

What muscles are most SENSITIVE (recovers quickest from paralysis)?

Answer 12

extraoccular, adductor pollicis, diaphragm, vc

Question 13

the _____ reflects the block of the diaphragm better than the adductor pollicis?

Answer 13

orbicularis oris

Question 14

Disadvantage of the adductor pollicis monitor?

Answer 14

possibility of movement of the diaphragm even with NO TOF.

Question 15

advantage of the adductor pollicis monitoring?

Answer 15

if fully recovered, there is no residual blockade of the diaphragm.

Question 16

_____onset is faster, there is no difference in actual response or strength of response.

Answer 16

depolarizing

Question 17

what is the timing/strength of the TOF?

Answer 17

4 pulses, at 2 hz over two seconds, 0.5 s apart

Question 18

what is the strength of tetanic stimulation?

Answer 18

50hz- 200 hz for 5 seconds (when you have a post tetanic twitch it takes 15 mins to recover. SAME AS 1 STIMULI q20ms.

Question 19

what is the strength of single twitch?

Answer 19

0.1 to 1 hz

Question 20

what is the double burst strength?

Answer 20

two train of 3 twitches at 50 hz, 750 ms apart.

Question 21

onset of vocal cords and diaphragm paralyzation is faster or slower than adductor pollicis?

Answer 21

faster

Question 22

Vec, Roc, Atra, post-tetanic stimuli appears ___ mins before first TOF response?

Answer 22

10 mins

Question 23

for Pancuronium, post-tetanic stimuli appears ___ mins before first TOF resopnse

Answer 23

35 mins

Question 24

Main use for _____ is evaluating the degree of blockade when there is now reaction to single twitch or TOF?

Answer 24

PTC

Question 25

Double burst is most useful during?

Answer 25

post reversal

Question 26

if 4/4 twitches, full reversal is assured within ___ minutes of reversal agent given.

Answer 26

10 mins

Question 27

what are three phases of NDMB?

Answer 27

1. intense blockade
2. moderate or surgical blockade
3. recovery phase

Question 28

What is the intense phase?

Answer 28

occurs within 3-6 mins, period of no response, length will vary based on agen, dose and sensitivity

Question 29

What is the moderate or surgical block phase?

Answer 29

begins when first TOF appears, antagonism shouldn’t be initiated. characterized by gradual return or TOF.

Question 30

Recovery phase begins when?

Answer 30

when 4 twitches are present. TOF ratio >0.75 indicates adequate recovery.