Other Monitors

Question 1

Temperature monitoring

Answer 1

the temperature of patients undergoing GA must be monitored

Question 2

Hypothermia complications

Answer 2

is associated with delayed drug metabolism, increased blood glucose, vasoconstriction, impaired coagulation, and impaired resistance to surgical infection

Question 3

Hyperthermia complications

Answer 3

leads to tachycardia, vasodilation, and neurological injury

Question 4

Tympanic Membrane Monitoring

Answer 4

theoretically reflects brain temperature because the auditory canal’s blood supply is the external carotid artery

Question 5

Rectal Temperatures

Answer 5

have slow response to changes in core temperature

Question 6

Nasopharyngeal probes

Answer 6

prone to cause epistaxis, but accurately measure CORE temperature if placed adjacent to the nasopharyngeal mucosa

Question 7

Axillary Temperature

Answer 7

there is variable correlation between axillary temp and core temp depending on skin perfusion

Question 8

Liquid Crystal Adhesive Strips

Answer 8

these are placed on the skin and are inadequate indicators of core body temp during surgery

Question 9

Esophageal Temperature Sensors

Answer 9

often incorporated into esophageal stethoscopes, provide the BEST combination of economy, performance, and safety.

To avoid measuring temp of tracheal gases, the temp sensor should be positioned BEHIND THE HEART in the LOWER THIRD of the esophagus

Question 10

Urinary Output

Answer 10

is a reflection of kidney perfusion and function and an indicator of renal, cardiovascular, and fluid volume status.

Question 11

Oliguria

Answer 11

inadequate urinary output is defined as output less than 0.5 mL/kg/hr

This is a function of the patient’s concentrating ability and osmotic load

Urine electrolyte composition, osmolality, and specific gravity aid in the differential diagnosis of oliguria

Question 12

Peripheral Nerve Stimulator Current

Answer 12

delivers a current of 60-80 mA to a pair of either ECG silver chord pads or subcutaneous needles placed over a peripheral motor nerve

Question 13

Most commonly monitored areas for peripheral stimulation?

Answer 13

ulnar nerve stimulation of the adductor pollicis muscle

facial nerve stimulation of the orbicular is oculi

Question 14

Train of Four Stimulation

Answer 14

denotes 4 successive 200-us stimuli in 2 sec (2 Hz)

The twitches in a TOF pattern progressively fade as NONDEPOLARIZING muscle relaxant block increases

Question 15

Disappearing Twitches

Answer 15

disappearance of the 4th twitch represents 75% block

the 3rd twitch represents 80% block

the 2nd twitch represents 90% block

Clinical relaxation requires 75-95% neuromuscular blockade

Question 16

Tetany

Answer 16

at 50 or 100 Hz is a sensitive test of neuromuscular function

sustained contraction for 5 sec indicates adequate - but not complete - reversal from NMB

Question 17

Double Burst Stimulation (DBS)

Answer 17

represents two variations of tetany that are less painful to the patient

Question 18

DBS 3,3 Pattern

Answer 18

consists of 3 short (200 us) high frequency bursts separated by 20 ms interval (50 Hz) followed 750 ms later by another 3 bursts

Question 19

DBS 3, 2 Pattern

Answer 19

consists of 3 200 us impulses at 50 Hz followed 750 ms later by two such impulses

Question 20

DBS pros

Answer 20

it is more sensitive than TOF stim for clinical (visual) evaluation of fade

Question 21

Muscle Group Differences

Answer 21

muscle groups differ in their sensitivity to NMB agents

recovery of adductor pollicis function does not exactly parallel recovery of muscles required to maintain an airway

Question 22

Which muscles recover first?

Answer 22

The diaphragm, rectus abdominis, laryngeal adductors, and obicularis oculi muscles recover from NMB sooner than do the adductor pollicis

Question 23

Other indicators of adequate muscle recovery

Answer 23

sustained (>5s) head lift, the ability to generate an inspiratory pressure of at least -25cm H2O, and a forceful hand grip

Question 24

Postoperative Residual Curarization (PORC)

Answer 24

remains a problem in post anesthesia care, producing injurious airway and respiratory compromise