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Anes. Pharm I Test 1

implications for administration and monitoring of NMB agents

QuestionAnswer
What is onset time? time from administration to maximum effect
What is clinical duration? time from administration to 25% recovery of a twitch response
What is total duration? time from administration to 90% recovery of twitch response
What is recovery index? time to go from 25% to 75% recovery of twitch response
What is ED95? the dose needed to produce 95% suppression of single twitch response
The intubating dose is usually __x to __x the ED95 dose 2x 3x
What are the objectives of clinical monitoring of neuromuscular function? titration of dosage of NMB to desired effect, monitor for unusual resistance or sensitivity or prolonged action of a NMB, evaluation of reversibility, determine recovery
What muscle does the ulnar nerve innervate and what motion does it cause when stimulated? adductor pollicis brevis adduction of the thumb
When the posterior tibial nerve is stimulated what action does it cause? plantar flexion of the great toe
When the lateral popliteal or peroneal nerve is stimulation what action will it cause? dorsiflexion of the foot
When monitoring muscle movement due to stimulation of facial nerve, be sure to place black electrode close to the ________ tragus of the ear
What is the response when the facial nerve is stimulated? eyelid movement via the orbicularis occuli muscle
Which site is the best place to monitor onset? facial nerve stimulation (orbicularis occuli)
What is the best place to monitor recovery? ulnar nerve stimulation (adductor pollicis brevis)
What is the single twitch stimulus? single twitch at 0.1 Hz - 4 Hz
The advantage of single twitch stimulus is that it is very low stimulation. What is the main disadvantage? must have baseline twitch response to compare
What is Train of Four? Four stimuli delivered over 2 seconds at 4 Hz
4 out of 4 twitches on TOF means __ % block 70 - 75%
3 out of 4 twitches on TOF means __ % block 80%
2 out of 4 twitches on TOF means __ % block 90%
clinical relaxation requires __ % - __ % block 75% to 90%
surgical relaxation requires __ % - __ % block 90% to 95%
The goal in anesthesia is 1 out of 4 on TOF throughout the case. Why? So that you can reliably reverse
With which type of NMB agents will you see a fade? non depolarizing phase II block with depolarizer
All 4 twitches will be equally reduced with which type of NMB? depolarizing
What are the indications of TOF monitoring? monitoring maintenance and clinical determining of relaxation; good to use to guide re-dosing
What is the disadvantage of TOF monitoring? not ideal for assessing recovery
What is double burst stimulation? two short bursts of three twitches at 50 Hz
What are the advantages of double burst stimulation? improves ability to detect residual paralysis during recovery; allows better comparison of 1st twitch to 4th twitch
What is tetanic stimulation? continuous stimulation for 5 seconds at 50 to 100 Hz
When is tetanic stimulation used? to assess recovery
Why must you wait 10 minutes after tetanic stimulation to stimulate with another method? false high readings will occur prior to 10 minutes
What is post tetanic twitch? 5 second 50 Hz tetanus, then 3 second pause followed by single twitch stimuli (in real world, more than likely followed by several TOF in a row)
What is the indication for post tetanic twitch? used to estimate time until reversal can be reliably given
A post tetanic twitch of ___ correlates with 1 out of 4 twitches on TOF 10
What is the order of onset of block regarding muscles? small rapid moving muscles (larynx) >>> long muscles >>> intercostal muscles and diaphragm
What is the order of recovery from block regarding muscles? diaphragm >>> rapidly moving muscles >>> long muscles
Post tetanic twitch of 1 means average time until reversal can be reliably given is ___ minutes for long acting and ___ minutes for intermediate acting 30 minutes 8 minutes
Avoid using a peripheral nerve stimulater on a paralyzed limb because it will give you falsely _____ twitch monitor readings, causing __________ of block high underestimation
the black (negative) electrode is placed directly over the nerve
With only 1 twitch in TOF, adequate reversal may take as long as ___ minutes 30
With 2 to 3 twitches in TOF, recovery make take from __ to __ minutes 4 to 12 minutes
with 4 twitches on TOF, recovery can be achieved within __ minutes with neostigmine or __ to __ minutes with edrophonium 5 minutes (neostigmine) 2 to 3 minutes (edrophonium)
What should you always check after reversal is given? sustained tetanus
Do not intubate until twitch is essentially _______ absent
Use TOF and sustained tetanus in that order to assess fade after ______ reversal
Created by: Mary Beth