Emergence from Anesthesia Flashcards
How to assess the depth of NMB objectively?
Train of Four – Adductor Pollicis or Orbicularis Oculi
>90%- 0 twitches
90% – 1 twitch
80% - 2 twitches
75% - 3 twitches
<75% - 4 twitches (Will allow you to breathe with small tidal volume)
When is it okay to reverse with Neostigmine?
Objectively
Post-tetanic stimulation and return of 1 twitch = 10 mins
At least 1 twitch represents 90 % blockade and no free drug therefore, reliably reversible
Subjectively
Spontaneous respiratory effort
Less than 100% blockade, therefore, reliably reversible
Symptoms of cholinergic crisis?
Wet
Bronchospasm
Paralysis
Bradycardia
Symptoms of anti-cholinergic crisis?
Dry
Hyperthermia
Urinary Retention
Tachycardia
Delayed emergence
What is the minimum waiting time is necessary before administration of a steroidalneuromuscular blocking agent after administration of Sugammadex?
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If rocuronium is reversed with Sugammadex, and rocuronium is readmistered within 30 minutes how long will the onset be delayed? How much shorter will the duration of action?
Onset delayed 4 minutes
Duration shortened 15 minutes
What is the recommended waiting time for patients with renal impairment that used rocuronium and reversed with 4mg/kg suggamadex? Or in healthy patients that were reversed with 16mg/kg suggamadex?
24 hours
What can you sometimes use to see if a patient is at baseline respiratory values?
Write respirometer
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T or F. Spontaneous breathing with adequate TV is a reliable way to assess NMB reversal
Spontaneous breathing with adequate TV is still unreliable as diaphragm much more resistant to NMB than airway muscles (i.e. tongue)
False
Sustained tetanus 50-100Hz >5s without fade indicates only ____ blockade
50%
TOF, seeing 4 twitches are subjective and indicate only ___ blockade
75%
TOF ratio of _____is the gold standard and suitable for extubating*
>0.7-0.9
*Really not that reliable nor available
Okay to pull the tube? SpO2 > 93% on FiO2 < 0.5
Yes, as long as it is stong respirations and they are not hypertensive
Glabellar tap
Glabellar reflex (also known as the “glabellar tap sign”)
Primitive reflex
Elicited by repetitive tapping on the forehead
Patient blinks in response to the first several taps
Appropriate steps if surgeon needs a little more time
Propofol 20-50mg
Lidocaine 1-1.5mg/kg
ED95 of muscle relaxants is usually 1/3 intubating dose
Hyperventilate
Increase inhaled volatile concentration
N2O
Communicate with surgeon