4 nmb Flashcards
When a phase 2 block with sux occurs
> 7-10 mg/kg. 30-60 min iv infusion
Best place to measure onset of blockade
Orbicularis oculi or corrugated supercilii, facial nerve
Best places to measure recovery from blockade
Adductor pollicis (thumb adduction) or flexor hallucis. Ulnar or pt nerve
NMB recovery= TOF
<0.9
TV: acceptable endpoint, max % receptors occupied
> 5ml/kg, 80
TOF: acceptable endpoint, max % receptors occupied
No fade, 70
VC: acceptable endpoint, max % receptors occupied
> 20 ml/kg, 70
Sustained tetanus, DBS: acceptable endpoint, max % receptors occupied
No fade, 60
Insp force: acceptable endpoint, max % receptors occupied
Better than -40 (more neg the better), 50
Head lift >5 sec, hand grip: endpoint, % receptors
Sustained 5 seconds, 50
Holding tongue blade: %occipied
50
How sux causes bradycardia, when to give atropine
M2 receptor on sa node, 2nd dose increases risk. Due to metabolite of sux. Atropine should be given to kids before 2nd dose of sux
How sux affects intragastric pressure, esoph tone, and barrier pressure at GE junction
Inc, raises lower esoph tone, and unchanged pressure at ge junction
Things attenuated by a defasciculating dose
Little to no benefit with IOP. Inc Intragastric pressure, ICP
Enzymes that metabolize acetylcholine 5
Type 1 cholinesterase, acetylcholinesterase, true cholinesterase, specific cholinesterase, genuine cholinesterase
Metab sux, miva, and ester LAs 5
Type 2 cholinesterase, butyrlcholinesterase, false cholinesterase, plasma cholinesterase, pseudocholinesterase
Pseudocholinesterase: made by what, when NM symptoms appear/when Serious
Liver. 60%, 20%
Drugs that reduce pseudocholinesterase activity
Reglan, esmolol, neostigmine, echothiophate, BC/estrogen, cyclophosphamide, MAOIs, nitrogen mustard
Co existing conditions that reduce pseudocholinesterase activity
Atypical pche, severe liver disease, chronic renal disease, organophosphate poisoning, burns, cancer, older, malnutrition, late state pregnancy
What dibucaine is
Amide LA that inhibits normal plasma cholinesterase but has no effect on atypical pche
What a nml v abnormal dibucaine test looks like
Normal= 80, dibucaine inhib 80% of pseudocholinesterase and a nml enzyme is present. Abn= 20, dibucaine didn’t inhib the pts pche and an atypical variant is present
Pche variant/dibucaine number/sux duration: typical homozygous, heterozygous, atypical heterozygous
70-80/5-10 min. 50-60/20-30 min. 20-30 4-8 hours
What will restore plasma pseudocholinesterase levels in a pt with an atypical variant
Ffp, whole blood, or purified human cholinesterase
In hyperkalemia: how to tx with stabilizing the myocardium
Ca cl 20 mg/kg or ca gluconate 60 mg/kg
