Inhaled Anesthetics, NMBD

Question 1

Halothane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure

Answer 1

B:G = 2.54
MAC = 0.75%
Vapor Pressure = 243 torr

Question 2

Enflurane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure

Answer 2

B:G = 1.90
MAC = 1.63%
Vapor Pressure = 175 torr

Question 3

Isoflurane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure

Answer 3

B:G = 1.46
MAC = 1.17%
Vapor Pressure = 238 torr

Question 4

What is MAC awake, MAC asleep, and MAC Bar of Isoflurane on a 35yo pt?

Answer 4

MAC Awake (0.3-0.5%): 0.351-0.585
MAC asleep (1.3%): 1.521
MAC bar (1.7-2%): 1.989-2.34

Question 5

Nitrous Oxide
Blood:Gas Partition Coefficient
MAC

Answer 5

B:G = 0.46
MAC = 104%

Question 6

Desflurane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure

Answer 6

B:G = 0.42
MAC = 6.6%
Vapor Pressure = 669 torr

Question 7

What is MAC awake, MAC asleep, and MAC Bar of Desflueane on a 35yo pt?

Answer 7

MAC awake (0.3-0.5%): 1.98-3.3
MAC Asleep (1.3%): 8.58
MAC bar (1.7-2%): 11.22 - 13.2

Question 8

Sevoflurane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure

Answer 8

B:G = 0.69
MAC = 1.8%
Vapor Pressure = 157 torr

Question 9

What is MAC awake, MAC asleep, and MAC Bar of Sevoflurane on a 35yo pt?

Answer 9

MAC awake (0.3-0.5%): 0.54 - 0.9
MAC asleep (1.3%): 2.34
MAC bar (1.7-2%): 3.06 - 3.6

Question 10

1 Hz/second decreasing to 0.1 Hz q 10 seconds

Answer 10

Single Twitch

Question 11

3 short bursts followed by 3 short bursts
Uses 50 Hz

Answer 11

Double Burst

Question 12

4 stimuli at 2 Hz in ½ second

Answer 12

Train of Four

Question 13

Very rapid, 50 Hz for 5 seconds – Continuous

Answer 13

Tetanic Stimulation

Question 14

Single twitch 3 seconds after tetanic stimulation

Answer 14

Post-Tetanic Stimulation

Question 15

Succinylcholine:
Dose
Onset
Duration

Answer 15

1 - 1.5 mg /kg IV
Onset - 30 to 60 seconds
Duration - 3 to 5 minutes

Question 16

Lower Dibucaine # indicates what?

Answer 16

Prolonged Succinylcholine effects - No butyrylcholinesterase

Question 17

High Dibucaine # indicates what?

Answer 17

Normal response to Succinylcholine

Question 18

Dantrolene
Use
Dose
Max dose

Answer 18

Malignant Hyperthermia
2 mg/kg IV
Max dose 10 mg/kg IV

Question 19

MACawake

Answer 19

0.3-0.5 MAC

Question 20

MAC-BAR

Answer 20

1.7-2.0 MAC

Question 21

For each decade above 50 years old, MAC decreases by..

Answer 21

6%

Question 22

Pancuronium (Pavulon)
Intubating Dose:
Onset:
Duration:
Short or long-acting?

Answer 22

Intubating Dose: 0.1 mg/kg
Onset: 3-5 mins
Duration: 60-90 mins
Most common long-acting NMBD

Question 23

What are the four intermediate-acting NMBDs?

Answer 23

Vecuronium
Rocuronium
Cisatracurium
Atracurium

Question 24

Vecuronium (Norcuron)
Intubating Dose:
Onset:
Duration:

Answer 24

Intubating Dose: 0.1 mg/kg
Onset: 3-5 mins
Duration: 20-35 mins

Question 25

Rocuronium (Zemuron) Intubating Dose: Onset: Duration:

Answer 25

Intubating Dose: 0.6 mg/kg or 1.2 mg/kg Onset: 3-5 mins; 1-2 mins with a larger dose Duration: 20-35 mins

Question 26

Cisatracurium (Nimbex) Intubating Dose: Onset: Duration:

Answer 26

Intubating Dose: 0.1 mg/kg Onset: 3-5 mins Duration: 20-35 mins

Question 27

Mivacurium (Mivacron) Intubating Dose: Onset: Duration:

Answer 27

Intubating Dose: 0.15 mg/kg Onset: 2-3 mins Duration: 12-20 mins | Not used much anymore - "move-a-curium"

Question 28

What muscle are the best indicators of diaphragmatic and laryngeal neuromuscular blockade?

Answer 28

Orbicularis Oculi & Corrugator Supercilli (Facial nerve)

Question 29

What muscle is most resistant to neuromuscular blockade?

Answer 29

Diaphragm

Question 30

What muscle is the gold standard for determination of NMB recovery?

Answer 30

Adductor Pollicis (ulnar nerve)

Question 31

What four factors determine how much a muscle is subject to neuromuscular blockade?

Answer 31

- # of presynaptic ACh vesicles - # of postsynaptic ACh receptors - Blood flow to muscle - NMB potency

Question 32

Faster onset of neuromuscular blockade to a muscle means that that muscle experiences a ____ recovery.

Answer 32

Slower