Exam 2 part VII

Question 1

which PNS twitch pattern detects residual block

Answer 1

tetany

Question 2

phase I block is a term used to define a _______________ blockade

Answer 2

depolarizing

Question 3

characteristic of phase I block with single twitch PNS

Answer 3

decreased contraction

Question 4

characteristic of phase I block with tetany PNS

Answer 4

decreased amplitude but sustained response; NO fade

Question 5

characteristic of TOF and double burst PNS with phase I block

Answer 5

no fade; the twitches are weaker but all have the same intensity

Question 6

post-tetanic facilitation (potentiation) is ___________ with phase I block and _______________ with phase II block

Answer 6

absent; present

Question 7

administration of anticholinesterases will _______________ a phase I block and ______________ a phase II block

Answer 7

augment; antagonize (reverse)

Question 8

fasculations are only present with a phase _________ block

Answer 8

I

Question 9

T4/T1 ratio with phase I block

Answer 9

> 0.7

Question 10

T4/T1 ratio with phase II block

Answer 10

< 0.7 (indicator of fade)

Question 11

pretreatment with NDMR on a phase I block will _____________ the block, but with phase II block it will ______________

Answer 11

antagonize; augment

Question 12

phase II block is produced under what circumstances?

Answer 12

1. NDMR administration 2. repeated, large, or continuous dose of succinylcholine (>6 mg/kg)

Question 13

T/F: a succinylcholine phase II block is reversible

Answer 13

false; non-reversible

Question 14

what is potentiation (with PNS)

Answer 14

when the intensity of the first twitch post-tetanic is higher than the baseline twitch

Question 15

indicators of NMBA recovery

Answer 15

1. sustained head lift/leg lift for at least 5 seconds 2. ability to generate inspiratory pressure of -25 cmH20 3. forceful hand grip and lets go on command 4. adequate Tv (10 mL/kg = ideal) and RR 5. respirations are smooth and unlabored 6. pt opens eyes widely on command with no diplopia 7. no fade with double burst stimulation 8. sustained protrusion and purposeful movement of tongue 9. effective swallowing 10. sustained bite (NOT DIRECTLY ON TUBE) 11. in small children - strong knee to chest movement 12. effective cough 13. sustained tetanic response to 50-100 Hz for 5 s 14. TOF ratio > 0.9 with NO fade

Question 16

when there is only 1 twitch response on the TOF, reversal may take up to _____________

Answer 16

30 min

Question 17

place the anatomical muscle in order from which ones would be blocked first with NMBA to the ones that would be blocked last (most resistant)

Answer 17

1. extraocular muscle (first blocked) 2. pharyngeal 3. masseter 4. adductor pollicis 5. abdominal rectus 6. obicularis oculi 7. diaphragm 8. vocal cords (last blocked - most resistant)

Question 18

the muscles that are most resistant to NMBA (last blocked) will be the ____________ to recover

Answer 18

first

Question 19

T/F: if you have administered NMBA but you start to see diaphragmatic movement (curare cleft on the EtCO2) you know the vocal cords are also recovered

Answer 19

TRUE

Question 20

99-100% of receptors are occupied by NMBA, you know the clinical response of the pt should be _________________, and there should be ___/4 TOF twitches

Answer 20

complete paralysis, flaccid; 0

Question 21

95% of receptors occupied by NMBA, the clinical response is _____________ and there should be _____/4 TOF twitches

Answer 21

diaphragmatic movement (curare cleft); 0

Question 22

90% of receptors are occupied by NMBA the clinical response would be __________________, and there should be ______/4 TOF twitches

Answer 22

abdominal relaxation for most intrabominal procedures; 1

Question 23

when pt Tv returns to normal (> 5mL/kg) post NMBA administration, you know _____________% of receptors are occupied and your single twitch will be __________ to baseline

Answer 23

75-80; equal

Question 24

when 70-75% of receptors are occupied by NMBA, what nerve stimulator response would you expect

Answer 24

1. no palpable fade in TOF (useful to gauge recovery) 2. sustained tetany (reliable indicator of recovery)

Question 25

when 60-70% of receptors are occupied by NMB what nerve stimulator response would you expect

Answer 25

no palpable fade in double burst stimulation

Question 26

T/F: double burst is a more senstive indicator of NMBA recovery than TOF

Answer 26

TRUE

Question 27

when 50% of receptors are occupied by NMBA, what clinical response is expected

Answer 27

1. generates inspiratory pressure of -40cmH20 2. head lift for 5 s 3. strong handgrip 4. sustained bite

Question 28

reversal of NMBA should not be initiated before at least ____________ twitches are present on TOF

Answer 28

2

Question 29

what is the order in which the NMBA were created

Answer 29

1. succinylcholine (1951) 2. pancuronium (68) 3. vecuronium, atracurium (82) 4. rocuronium (94) 5. cisatracurium (96)

Question 30

what year was suggamdex FDA approved for use in the US

Answer 30

2015

Question 31

T/F: acetycholine due to its chemical structure has a permanent positive charge regardless of pH

Answer 31

TRUE

Question 32

the greater potency of NDMR = _____________ dose = _____________ speed of onset

Answer 32

decreased; decreased (decreased speed of onset = increased onset time)

Question 33

larger dose of NDMR _____________ speed of onset –> _________________ duration of blockade and s/e

Answer 33

increases; increased

Question 34

__________________ prolongs NDMR blockade

Answer 34

hypothermia and respiratory acidosis

Question 35

______________ dose of NDMR in burn pts

Answer 35

increase (2/2 upregulation of xtrajx R)

Question 36

what electrolyte imbalances AUGMENT NDMR

Answer 36

1. hypokalemia 2. hypocalcemia 3. hypermagnesemia

Question 37

modification of NDMR dose in neonates

Answer 37

no change in dose

Question 38

with cirrhotic liver dz/chronic renal failure you should ___________ the loading dose and ______________ the maintenance dose of the NDMR

Answer 38

increase; decrease