Question | Answer |
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 |