NMBD

Question 1

Succinylcholine dosage:

Answer 1

1 mg/kg - 60 sec onset

9-13 minutes to recover to 90% strength

Question 2

Why rapid recovery?

Answer 2

SCH is rapidly metabolized in plasma by pseudocholinesterase. SCH rapidly diffuses away from NMJ - no pseudocholinesterase present in NMJ

Question 3

What else does pseudocholinesterase metabolize?

Answer 3

SCH, mivacurium, procaine, chloroprocaine, tetracaine, cocaine, heroin

Question 4

Dibucaine test numbers:

Answer 4

> 70 - normal
40-60 heterozygous 1.5-2x longer
<30 homozygous 4-8 hrs

Question 5

SCH cardiovascular effects:

Answer 5

Bradycardia, junctional rhythm, sinus arrest

Question 6

SCH kalemia effects:

Answer 6

Increase 0.5 mEq/dL in healthy individuals

Question 7

Susceptible to hyperkalemia:

Answer 7

burn, severe abdominal infections, metabolic acidosis, closed head injury, hemi or paraplegia, muscular dystrophies, guillain-barre

Question 8

Intermediate acting steroid agents

Answer 8

Vecuronium, Rocuronium

Question 9

Intermediate acting benzlisoquinolinium

Answer 9

Atracurium, Cisatracurium

Question 10

Steroid NMBA potency

Answer 10

Pan>Van>Roc

Question 11

Vecuronium metabolism:

Answer 11

Liver is principle organ, 30-40% cleared in bile unchanged. Renal 30%

Question 12

Rocuronium metabolism:

Answer 12

Primarily eliminated by the liver and excreted in bile

Question 13

Factors that increase non-depolarizing potency

Answer 13

• Inhalational anesthetics (Des>Sevo>Iso) - decrease the dosage required, prolong the duration of action and time to recovery
• Aminoglycosides, clindamycin
• Hypothermia, magnesium sulfate

Question 14

NMBA that release histamine?

Answer 14

Benzylisoquinolinium agents - atracurium, mivacurium, tubocurarine