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Priniclpes Of Anesthesia > Exam 5 NMB > Flashcards

Exam 5 NMB Flashcards

1
Q

depolarizing muscle relaxant

A

succinylcholine

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2
Q

Succinylcholine MOA

A

mimics action of ACH by binding to the motor endplate

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3
Q

Phase I block

A

SUCC

motor endplate closes and cannot reopen until depolarization (can’t happen when depolarizer is bound)

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4
Q

Succincholine is an

A

ACH receptor agonist

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5
Q

plasma cholinesterase aka

A

pseudocholinesterase

butylcholinesterase

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6
Q

Succinylcholine unique abilities

A

fast onset (34 seconds)
short duration (2-4) min

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7
Q

Non-depolarizers are

A

ACH competitive receptor antagonists

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8
Q

Non-depolarizer MOA

A

Compete with ACH for motor end plate - bind but do NOT cause conformational change

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9
Q

Reversal of non-depolarizing muscle relaxants concept

A

whoever has more at synaptic cleft wins
More Ach: conformational change
More non-depolarizing agent: no conformational change = no contraction

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10
Q

Non-depolarizer REVERSALagents are

A

cholinesterase inhibitors

allows for accumulation of Ach to win battle of who has more wins

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11
Q

Suggammadex MOA and which drugs it works on

A

selectively binds to NMBD

drugs: rocuronium, vecuronium, pancuronium

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12
Q

Sugammadex considerations

A

birth control interference - 7 days

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13
Q

Peripheral nerve stimulation indications

A

used to monitor degree of NMB:
1. assess conditions for endotracheal intubation
2.. asses if degree of block is sufficient for surgery
3. Monitor recover from block and successful extubation

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14
Q

Single twitch (use and energy)

A

0.1 to 1.0 Hz
compare to baseline twitch before drug administration

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15
Q

Train of four (use, energy, timing)

A

want ratio of 0.9 (4th twitch is at least 90% of 1st twitch)

four equal 2.0 hz 0.5 sec apart

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16
Q

Double burst stimulation (energy, timing, use)

A

two short bursts of 50 hx tetanus separated by 0.75 seconds

Similar to train of 4 (may be easier to detect)

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17
Q

Tetanus (energy, timing, use)

A

rapid 30-50 or 100 Hz for 5 seconds

deep block assessment - painful, use sparingly

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18
Q

Postetanic count (energy, timing, use)

A

50 Hz for 5 sec, 3 sec pause, single twitches of 1 Hz

used when TO4 is absent, deep block, or prolonged recovery likely

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19
Q

With neuromuscular blockade, what will you see with different twitch stimulation?

A

Single twitch: Less movement (cannot clinically give much info. need baseline twitch)

TO4: fade

Tetanus: decreased contraction over duration

Post tetanic twitch: fade

Double burst: fade

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20
Q

TO4 use

A

distinguishes between depolarizing and non-depolarizing blocks

*useful in determining recovery from NONDEPOLARIZING muscle relaxants

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21
Q

wiht TO4, 4 twitches can still be ____% blcoked

A

70%

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22
Q

with TO4, we want to avoid _____ twitches because ____

A

avoid 0 twitches because this is a 95% + block, and if we 100% block, we cant reverse fully (residual paralysis)

23
Q

Most common method in assessing clinical response to NMBs

A

TO4

24
Q

It is difficult to detect (visually or tactile) fade when TOF ration exceeds

A

0.4

need objective quantitative assessment when TO4 exceeds 0.4

25
Q

Clinical recover form NMB is achieved when TOF ratio is

A

0.9

26
Q

Reversal agent is indicated when TOF ration is

A

<0.9

27
Q

absence of fade:

A

does NOT guarantee adequate NMB recovery

can still have residual weakness

28
Q

Tetanus indication for depolarizing block:

A

response is depressed in amplitude but is sustained (no fade)
*unless phase 2 block

29
Q

Tetanus indication for nondepolarizing block

A

Response is depressed and NOT sustained (fade)

30
Q

Tetanus assessment with TO4 assessment

A

TO4 may not be accurate for up to 6 min following tetanus assessment

31
Q

Posttettanic count block indication

A

less than 8 twitches = deep block

32
Q

posttetanic count MOA

A

mobilizes excess of ACH so that after 3 second pause you can produce a short series of single twitch responses

33
Q

Posttetanic count of 6-8 means

A

reversal should occur in less than 10 minp

34
Q

postetanic count of 1-2 means

A

reversal will take more than 50 min

35
Q

Post tetanic count assesses

A

depth of NMB when no twitches are present in deep block

36
Q

With no fade during double burst stimulation:

A

MAY be recovered, but could be up to 70% blocked still

37
Q

Peripheral nerve stimulation monitoirng sites

A
  1. ulnar nerve (thumb adduction)
  2. facial nerve
  3. posterior tibial nerve
38
Q

Order of relaxation with NMB

A

eyes–>extremities–>trunk (neck then down)–abdominal–>diaphragm

*reversal is opposite

39
Q

Regions of higher blood flow have

A

faster onset and faster recovery

diaphragm–>masseter–>laryngeal muscles–>orbicularis oculi

40
Q

Presence of spontaneous ventilation

A

NOT a sign of adequate neuromuscular recovery

41
Q

Diaphragm recover vs upper airway muscle recover

A

diaphragm recovers much faster than upper airway muscle (i.e. genihyoid)

42
Q

genihyoid muscle relaxes at same time as

A

adductor pilus (thumb in TO4)

43
Q

What nerve is more helpful in determining ONSETof block

A

facial nerve

44
Q

What nerve is more helpful in determining strength or fuller RECOVER

A

ulnar nerve

45
Q

with adequate TV, a pt can still be (% blocked)

A

80% blocked
(not adequate for extubation)

46
Q

with no TO4 fade, a patient can still be (% blcoked)

A

70-75% blocked
(not adequate for extubation)

47
Q

with adequate VC, pt can still be (% blcoked)

A

70%
(not adequate for extubation)

48
Q

With no tetany fade, pt can still be (% blocked)

A

70% blocked
(not adequate for extubation)

49
Q

with adequate inspiratory pressure, pt can still be (% blocked)

A

50% blocked
(usually adequate for extubation)

50
Q

strong hand grip for 5 seconds pt can still be (% blocked)

A

50% (usually adequate for extubation)

51
Q

5 second head lift, patient can still be

A

50% blocked
(gold standard for extubation)

52
Q

The gold standard for extubation is

A

5 second head left

53
Q

if a paitnetcan hold tounge blade in mouth angainst force, they can still be

A

50% blcoked

Priniclpes Of Anesthesia (19 decks)

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