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General Principles > Exam 2- PNS > Flashcards

Exam 2- PNS Flashcards

1
Q

what can affect contact with the PNS?

A

diaphoresis, hair, edema, wounds

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2
Q

what nerve innervates the adductor pollicis muscle?

A

the ulnar nerve

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3
Q

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

A

recovery of upper airway muscle function

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4
Q

which muscle used for PNS recovers later than the diaphragm?

A

the adductor pollicis muscle

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5
Q

where are adductor pollicis nerve stimulator monitors placed?

A

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

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6
Q

what muscles are stimulated during facial nerve stimulation?

A

orbicularis oculi- covers the eyelid, produces eyelid squint

corrugator supercilii- covers the eyebrow

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7
Q

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

A

eyebrow stimulation

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8
Q

where are electrodes placed for facial nerve stimulation

A

red wire is proximal at the outer canthus

black wire is distal at the tragus

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9
Q

diaphragm paralysis vs adductor pollicis

A

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

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10
Q

face is not a good indicator of

A

extubation

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11
Q

which nerves are paralyzed faster and recover quicker?

A

facial nerves

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12
Q

posterior tibial nerve stimulation produces

A

plantar flexion of the big toe, comparable to adductor pollicis

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13
Q

where are the electrodes placed in posterior tibial nerve stimulation?

A

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

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14
Q

0.1 Hz

A

one stimuli every 10 seconds

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15
Q

what Hz causes sustained muscle contraction/tetanus without fade?

A

50 Hz

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16
Q

what can repeated simulation cause?

A

fatigue and increased blood flow to the area

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17
Q

which method of PNS is the least reliable method?

A

single twitch

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18
Q

what is single twitch PNS used for

A

to determine the onset of a block; NOT RECOVERY

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19
Q

train of four (TOF) stimuli

A

4 repetitive stimuli at 2 Hz (2/sec)

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20
Q

what PNS is associated with fade in NDMR?

A

train of four (TOF)

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21
Q

what is the minimum standard for determining extubation readiness?

A

TOFr/= 0.9

22
Q

fade ratio

A

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

23
Q

no muscle relaxant TOF ratio

A

1.0

24
Q

full muscle relaxant ratio

A

0

25
Q

which PNS method can detect a phase II block?

A

TOF

26
Q

100% blocked TOF

A

no response, flaccid, no TOF

27
Q

95% blocked TOF

A

no twitches, but the diaphragm may move

28
Q

90% blocked TOF

A

1 twitch on TOF, adequate relaxation of abdominal muscles

29
Q

70-75% blocked TOF

A

4 twitches on TOF, VC and TV can be normal

30
Q

30% blocked TOF

A

head lift/hand grasp sustained

31
Q

which kind of block would demonstrate fade?

A

a nondepolarizing block

32
Q

how would a depolarizing block appear during phase I?

A

constant but diminished

33
Q

how would a depolarising block appear during phase II?

A

fade, TOF <0.3

34
Q

what TOF indicates adequate surgical relaxation?

A

0.15-0.25

35
Q

what TOF indicates safe extubation and recovery

A

> 0.9

36
Q

describe tetanic (TET) stimulation

A

repetitive stimulation at a frequency >30 Hz

5s durations

fades when partially blocked

37
Q

which kind of stimulation is an indicator of residual NMB

A

TET stimulation

38
Q

which kind of stimulation fades when partially blocked

A

TET

39
Q

what kind of stimulation is used with sugammadex reversal?

A

post tetanic count (PTC)

40
Q

post tetanic count stimulus

A

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

41
Q

double-burst stimulation

A

two short bursts of tetanus at 50 Hz

each burst has 3 impulses lasting 0.2ms

42
Q

which stimulator has a greater magnitude of muscle response than TOF

A

double-burst stimulation

43
Q

nondepolarizing neuromuscular block

A

no twitch

44
Q

depolarizing block

A

phase I and phase II

phase I is preceded by muscle fasciculation

45
Q

which block has no fade?

A

depolarizing block (succinylcholine)

46
Q

which block does have fade?

A

nondepolarizing block

47
Q

which PNS site should be used during anesthesia induction

A

orbicularis oculi as it is more similar to a central muscle

48
Q

what simulation pattern should be used during induction?

A

single twitch or TOF

49
Q

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

A

adductor pollicis stimulation

50
Q

which method is BEST for PNS?

A

acceleromyography (AMG) because it provides a ratio

General Principles (6 decks)

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