NMB Reversals Flashcards
(84 cards)
1
Q
1995 Prospective Study on Vecuronium:
* No NM monitoring
* No Reversal
What was the Post-Op Residual NM Blockade?
A
33% ( n=435)
2
Q
2002, 2003, 2004 Studies on NMB
* Used NM monitoring
* Reversal Used
What was the Post-Op Residual NM blockade?
A
4%
3
Q
What is another name for neuromuscular monitoring?
A
Acceleromyography
4
Q
The most common location, nerve, and muscle monitor are?
A
- Hand
- Abductor Pollicis
- Ulnar Nerve
5
Q
Clinical Duration Response of Pancuronium
A
86 minutes
6
Q
Clinical Duration Response of Rocuronium
A
36 minutes
7
Q
Clinical Duration Response of Vecuronium
A
44 minutes
8
Q
Clinical Duration Response of Atracurium
A
46 minutes
9
Q
Clincial Duration Response of Cistracurium
A
45 minutes
10
Q
Clinical Duration Response of Mivacurium
A
8 minutes
11
Q
Edrophonium is most commonly paired with _______.
A
Atropine Sulfate
12
Q
Neostigmine is most commonly paired with ________.
A
Glycopyrrolate
13
Q
Name the (3) NMB Reversal Agents
A
- edrophonium
- Neostigmine
- Sugammadex
14
Q
Name the (2) Anti-Cholinergic Agents that are paired with NMBD Reversals
A
- Atropine
- Glycopyrrolate
15
Q
Name the (3) Classifications for NMBD Reversal Agents
A
- Acetylcholine (AchE) Inhibitors
- Cholinergic Agents
- Competive Antagoinst
16
Q
Time to Max Block: Panuronium
A
2.9 mins
17
Q
Time to Max Block: Rocuronium
A
- 1.7 mins
18
Q
Time to Max Block: Vecuronium
A
2.4 Mins
19
Q
Time to Max Block: Atracurium
A
3.2 mins
20
Q
Time to Max Block: Cistracurium
A
5.2 mins
21
Q
Time to Max Block: Mivacurium
A
3.3 mins
22
Q
Acetylcholinesterase (AchE) Inhibitors MOA:
* rapid ________ of ACH.
* AchE Inhibition = ______ Acetylcholine available.
* ACH binds to _______ subunits.
A
- Hydrolysis
- more
- alpha
23
Q
Acetylcholinesterase is available at:
* _________ (SNS & PNS)
* _________ junction
A
- Preganglionic
- Neuromuscular Junction (NMJ)
24
Q
Ceiling Effect of NMBD: Reversal Agents will not _______ with _____ NM Blockade
A
- work
- deep
25
Max dose of Neostigmine
| Ceiling Dose
40 to 70 mcg/kg
26
Max dose of Edrophonium
| ceiling dose
1mg/kg
27
Reversal of NM Blockade depends on (5) factors:
1. __________ of NM block
2. ________ inhibitor dose
3. ________ administed
4. Rate of Plasma __________ of NMBD
5. Anesthesia _________ of choice and depth (Post-Op Residual)
1. Depth
2. AchE
3. Dose
4. Clearance
5. agent
28
Succinycholine (Anectine)
Dose/Onset/Duration
* 1-1.5 mg/kg
* 30-60 sec
* 5-10 mins
29
Cisatricurium (Nimbex)
Dose/onset/duration
* 0.1 mg/kg
* 2-3 mins
* 40-75 mins
30
Vecuronium (Norcuron)
dose/onset/duration
* 0.1 mg/kg
* 2-3 mins
* 45-90 mins
31
Rocuronium (Zemuron)
RSI dose
dose/onset/duration
* 1.2 mg/kg
* 1.5 mins
* 35-75 mins
32
Pancuronium (Pavulon)
dose/onset/duration
* 0.1 mg/kg
* 2-3 mins
* 60-120 mins
33
Rocuronium (Zemuron)
dose/onset/duration
* 0.6 mg/kg
* 2-3 mins
* 35-75 mins
34
Edrophonium
dose/onset/duration
* 0.5-1 mg/kg
* 1-2 mins
* 5-15 mins
35
Neostigmine
dose/onset/duration
* 40-70 mcg/kg
* 5-10 mins
* 60 mins
36
NMBD Reversal agents are excretely by the ________ and _________.
* Renal
* Hepatic
37
Renal Excretion of NMBD:
* Neostigmine ____%
* Edrophonium ____%
* 50%
* 75%
38
Chronic Renal failure _______ plasma clearance and causes a ________ action.
* decreases
* prolonged
39
If there is no Renal Function, _____% to ____% of NMBD will be excreted Hepatically.
* 30-50%
40
Name the (5) systems that will have side effects associated with NMBD.
* Nicotinic/Muscarinic
* CV
* Pulmonary
* GI
* Eyes
41
NMBD _______ Nicotinic/Muscarinic Activity
Increase
42
NMBD causes _________, dysrhythmias, _________, and ________ SVR
* Bradycardia
* asystole
* decreased
43
NMBD cause ______________, ____ airway resistance and _____ salivation in the Pulmonary system.
* bronchoconstriction
* increased
* increased
44
NMBD causes _________, _____ gastric fluid secretion and ________ in the GI system.
* hyperperistalsis
* enhanced
* PONV
45
NMBD causes ____ in the eyes.
Miosis
46
To prevent side-effects _____ and _____ is given with NMBD reversals.
* Atropine
* Glycopyrolate
47
Name the drug classifications for Atropine and Glycopyrrolate.
* Anti-Cholinergic
* Anti-Muscarinic
48
With Cardiac disease, what Anti-Cholinergic/Anti-Muscarinic is prefered?
* Glycopyrrolate
49
Glycopyrolate should be given slowly over ___ - ___ minutes
* 2-5 mins
50
Atropine Dose
* 7 -10 mcg/kg
51
Name (2) side effects of Atropine
* mydriasis
* initial tachycardia
52
Dose and Max Dose of Glycopyrolate
* 7-15 mcg/kg
* Max 1 mg
53
A Persistent NM blockade is created when ______ is maximally inhibited and no further ______________ is effective.
* Acetylcholinesterase
* anticholinesterase
54
With a peristent NM blockade, you need to ensure proper _______ and ______ _______.
* sedation
* postop ventilation
55
Name (5) Factors Influencing NMBD Reversal:
* __________ of block
* __________ used
* Continued __________ Anesthetic
* _________ Drug used
* Patient condition
* Intensity
* NMBD
* Volatile
* Reversal
* Patient condition
56
Metabolic _______ , Respiratory _______ and Hypothermia can all affect NMB.
* acidosis
* acidosis
57
Name (3) other Reversal Drugs for NMBD
* Purified human plasma cholinesterase
* Cystiene
* Sugammadex
58
Sugammadex is a selectively binding agent with _______.
* aminosteroids
* Rocuronium
| Castillo kept relating Sugammadex to Roc in lcass. Notes say aminosteroi
59
Name the NMBD that Cystience works well with.
Gantacurium
60
AchE work by rapidly _______ of Acetylcholine.
* hydrolysis (catalyze)
61
Acetylcholine is available in the __________ and ________.
* Preganglionic (SNS & PNS)
* NMJ
62
Sugammadex is a γ- ________, containes ______ units from starch and is _______ water soluble.
* Cyclodextrin
* dextrose
* highly
63
Sugammadex MOA is due to its intermolecular (___ ____ ____) forces, thermodynamic (__________) bonds and hydrophobic interactions that causes a very tight reversal by __________.
* Van der Walls
* Hydrogen
* encapsulation
64
Name the (3) NMBD that Sugammadex reverses
* Rocuronium
* Vecuronium
* Pancuronium
65
Sugammadex bind to _____ drug in the plasma.
* Free
66
Sugammadex major route of elimination is the _______.
Urine
67
Sugammadex Moderate block Dose -- reappearance of second twitch.
* 2mg/kg
68
Sugammadex dose for Deep Block --- No twitch to TOF & 1-2 post-tentanic
* 4 mg/kg
69
The Elimination 1/2 time for Sugammadex is ___ hours.
* 2 hours
70
Sugammadex Dose with an extreme block
* 8 -16 mg/kg
71
Does Recurarization occur with Sugammadex?
* Not observed at appropriate dose.
72
Sugammade Side effects include N/V, ______, Urticaria, Anaphylaxis, _________, or it doesn't work.
* Pruritus
* Bradycardia
73
Suggamedex can cause issues when given to patient taking ______ contraceptives and ____________.
* Oral Contraceptives
* Toremifene
74
Tomemifene (non-steroidal anti estrogen) _______ NMBD from Sugammadex.
* displaces
75
Sugammadex when given to a pt taking oral contraceptives can ________ with Progesterone for ___ day. Making the oral contraceptive __________.
* Bind
* 7
* inactive
76
Suggamadex can cause an increasing in __________/ __________ when given with Heparin/LMWH and can __________ PTT, PT and INR.
* Coagulopathy/Bleeding
* Elevated
77
Recurarization (re-paralyzation) can only occur with Suggamedex when given a _________ than recommended dose.
Lower
78
Recurarization is immediately apparent in PACU d/t declining _____ and _________ effort.
* SaO2
* Respiratory
79
Signs and Symptoms of Recurarization include decrease O2 sats, ________ patient, appears _________ or uncoordinated and ineffective _____ and intercostal activity.
*unresponsive
* floppy
* abdominal
80
Does Edrophonium or Neostigmine have a longer duration of action?
Neostigmine
81
Treatment of Recurarixation is to treat urgently and _______, ________ the patient, and give additional ______ agents in divided doses.
* aggressively
* re-sedate
* reversal
82
When a patient experiences recurarization, the can sometime verbalize a _________ feeling, are unable to sustain a _____ lift or hand ______. In worst case senario, _________ collapse and respiratory obstruction.
* suffocating
* head
* grasp
* pharnygeal
83
Which non-depolarizing NMBD has the longest time to maximum block?
Cistracurium (5.2 mins)
84
