Exam 2 part VII Flashcards
which PNS twitch pattern detects residual block
tetany
phase I block is a term used to define a _______________ blockade
depolarizing
characteristic of phase I block with single twitch PNS
decreased contraction
characteristic of phase I block with tetany PNS
decreased amplitude but sustained response; NO fade
characteristic of TOF and double burst PNS with phase I block
no fade; the twitches are weaker but all have the same intensity
post-tetanic facilitation (potentiation) is ___________ with phase I block and _______________ with phase II block
absent; present
administration of anticholinesterases will _______________ a phase I block and ______________ a phase II block
augment; antagonize (reverse)
fasculations are only present with a phase _________ block
I
T4/T1 ratio with phase I block
> 0.7
T4/T1 ratio with phase II block
< 0.7 (indicator of fade)
pretreatment with NDMR on a phase I block will _____________ the block, but with phase II block it will ______________
antagonize; augment
phase II block is produced under what circumstances?
- NDMR administration 2. repeated, large, or continuous dose of succinylcholine (>6 mg/kg)
T/F: a succinylcholine phase II block is reversible
false; non-reversible
what is potentiation (with PNS)
when the intensity of the first twitch post-tetanic is higher than the baseline twitch
indicators of NMBA recovery
- 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
when there is only 1 twitch response on the TOF, reversal may take up to _____________
30 min
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)
- 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)
the muscles that are most resistant to NMBA (last blocked) will be the ____________ to recover
first
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
TRUE
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
complete paralysis, flaccid; 0
95% of receptors occupied by NMBA, the clinical response is _____________ and there should be _____/4 TOF twitches
diaphragmatic movement (curare cleft); 0
90% of receptors are occupied by NMBA the clinical response would be __________________, and there should be ______/4 TOF twitches
abdominal relaxation for most intrabominal procedures; 1
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
75-80; equal
when 70-75% of receptors are occupied by NMBA, what nerve stimulator response would you expect
- no palpable fade in TOF (useful to gauge recovery) 2. sustained tetany (reliable indicator of recovery)
when 60-70% of receptors are occupied by NMB what nerve stimulator response would you expect
no palpable fade in double burst stimulation
T/F: double burst is a more senstive indicator of NMBA recovery than TOF
TRUE
when 50% of receptors are occupied by NMBA, what clinical response is expected
- generates inspiratory pressure of -40cmH20 2. head lift for 5 s 3. strong handgrip 4. sustained bite
reversal of NMBA should not be initiated before at least ____________ twitches are present on TOF
2
what is the order in which the NMBA were created
- succinylcholine (1951) 2. pancuronium (68) 3. vecuronium, atracurium (82) 4. rocuronium (94) 5. cisatracurium (96)
what year was suggamdex FDA approved for use in the US
2015
T/F: acetycholine due to its chemical structure has a permanent positive charge regardless of pH
TRUE
the greater potency of NDMR = _____________ dose = _____________ speed of onset
decreased; decreased (decreased speed of onset = increased onset time)
larger dose of NDMR _____________ speed of onset –> _________________ duration of blockade and s/e
increases; increased
__________________ prolongs NDMR blockade
hypothermia and respiratory acidosis
______________ dose of NDMR in burn pts
increase (2/2 upregulation of xtrajx R)
what electrolyte imbalances AUGMENT NDMR
- hypokalemia 2. hypocalcemia 3. hypermagnesemia
modification of NDMR dose in neonates
no change in dose
with cirrhotic liver dz/chronic renal failure you should ___________ the loading dose and ______________ the maintenance dose of the NDMR
increase; decrease
