Exam 2- PNS

Question 1

what can affect contact with the PNS?

Answer 1

diaphoresis, hair, edema, wounds

Question 2

what nerve innervates the adductor pollicis muscle?

Answer 2

the ulnar nerve

Question 3

what is nerve stimulation of the adductor pollicis muscle a good indication of?

Answer 3

recovery of upper airway muscle function

Question 4

which muscle used for PNS recovers later than the diaphragm?

Answer 4

the adductor pollicis muscle

Question 5

where are adductor pollicis nerve stimulator monitors placed?

Answer 5

electrodes are placed over the path of the ulnar nerve

black is distal at the level of the wrist on the ulnar surface

red is placed 1-2 cm proximal, parallel to the flexor capri ulnaris tendon

Question 6

what muscles are stimulated during facial nerve stimulation?

Answer 6

orbicularis oculi- covers the eyelid, produces eyelid squint

corrugator supercilii- covers the eyebrow

Question 7

which location of stimulation is a good predictor of good intubating conditions and profound block?

Answer 7

eyebrow stimulation

Question 8

where are electrodes placed for facial nerve stimulation

Answer 8

red wire is proximal at the outer canthus

black wire is distal at the tragus

Question 9

diaphragm paralysis vs adductor pollicis

Answer 9

diaphragm and laryngeal muscles take x2 the dose to paralyze compared to the adductor pollicis muscle

Question 10

face is not a good indicator of

Answer 10

extubation

Question 11

which nerves are paralyzed faster and recover quicker?

Answer 11

facial nerves

Question 12

posterior tibial nerve stimulation produces

Answer 12

plantar flexion of the big toe, comparable to adductor pollicis

Question 13

where are the electrodes placed in posterior tibial nerve stimulation?

Answer 13

2 cm posterior to the medial malleolus, second one is 2 cm above the first

Question 14

0.1 Hz

Answer 14

one stimuli every 10 seconds

Question 15

what Hz causes sustained muscle contraction/tetanus without fade?

Answer 15

50 Hz

Question 16

what can repeated simulation cause?

Answer 16

fatigue and increased blood flow to the area

Question 17

which method of PNS is the least reliable method?

Answer 17

single twitch

Question 18

what is single twitch PNS used for

Answer 18

to determine the onset of a block; NOT RECOVERY

Question 19

train of four (TOF) stimuli

Answer 19

4 repetitive stimuli at 2 Hz (2/sec)

Question 20

what PNS is associated with fade in NDMR?

Answer 20

train of four (TOF)

Question 21

what is the minimum standard for determining extubation readiness?

Answer 21

TOFr/= 0.9

Question 22

fade ratio

Answer 22

relationship between the size of the fourth twitch and the first twitch (T4/T1)

Question 23

no muscle relaxant TOF ratio

Answer 23

1.0

Question 24

full muscle relaxant ratio

Answer 24

0

Question 25

which PNS method can detect a phase II block?

Answer 25

TOF

Question 26

100% blocked TOF

Answer 26

no response, flaccid, no TOF

Question 27

95% blocked TOF

Answer 27

no twitches, but the diaphragm may move

Question 28

90% blocked TOF

Answer 28

1 twitch on TOF, adequate relaxation of abdominal muscles

Question 29

70-75% blocked TOF

Answer 29

4 twitches on TOF, VC and TV can be normal

Question 30

30% blocked TOF

Answer 30

head lift/hand grasp sustained

Question 31

which kind of block would demonstrate fade?

Answer 31

a nondepolarizing block

Question 32

how would a depolarizing block appear during phase I?

Answer 32

constant but diminished

Question 33

how would a depolarising block appear during phase II?

Answer 33

fade, TOF <0.3

Question 34

what TOF indicates adequate surgical relaxation?

Answer 34

0.15-0.25

Question 35

what TOF indicates safe extubation and recovery

Answer 35

>0.9

Question 36

describe tetanic (TET) stimulation

Answer 36

repetitive stimulation at a frequency >30 Hz 5s durations fades when partially blocked

Question 37

which kind of stimulation is an indicator of residual NMB

Answer 37

TET stimulation

Question 38

which kind of stimulation fades when partially blocked

Answer 38

TET

Question 39

what kind of stimulation is used with sugammadex reversal?

Answer 39

post tetanic count (PTC)

Question 40

post tetanic count stimulus

Answer 40

5 second, 50 Hz tetanic stimulus, followed 3s. later by a single twitch stimuli at 1 Hz

Question 41

double-burst stimulation

Answer 41

two short bursts of tetanus at 50 Hz each burst has 3 impulses lasting 0.2ms

Question 42

which stimulator has a greater magnitude of muscle response than TOF

Answer 42

double-burst stimulation

Question 43

nondepolarizing neuromuscular block

Answer 43

no twitch

Question 44

depolarizing block

Answer 44

phase I and phase II phase I is preceded by muscle fasciculation

Question 45

which block has no fade?

Answer 45

depolarizing block (succinylcholine)

Question 46

which block does have fade?

Answer 46

nondepolarizing block

Question 47

which PNS site should be used during anesthesia induction

Answer 47

orbicularis oculi as it is more similar to a central muscle

Question 48

what simulation pattern should be used during induction?

Answer 48

single twitch or TOF

Question 49

what muscle is the best option for PNS monitoring during reversal and recovery?

Answer 49

adductor pollicis stimulation

Question 50

which method is BEST for PNS?

Answer 50

acceleromyography (AMG) because it provides a ratio