Exam 4: 3/31 Lecture Flashcards
What is the purpose of evaluating assessment data from a nerve stimulator?
To assess neuromuscular function following various stimulation techniques
Techniques include single burst, double burst, TO4, tetany, and post-tetanic stimulation.
What factors should be applied when selecting NMBD reversal agents?
Pharmacodynamics (PD) and pharmacokinetics (PK) data
This includes the assessment of nerve stimulation data.
List some commonly used local anesthetics for postoperative pain.
- Bupivacaine
- Lidocaine
- Ropivacaine
Each has specific doses, effects, side effects, indications, and contraindications.
Why is monitoring important in anesthesia?
To ensure patient safety and effective neuromuscular function assessment
Monitoring helps detect complications early.
What are NMBD reversal agents?
- Edrophonium
- Neostigmine
- Pyridostigmine
- Physostigmine
These agents are used to reverse the effects of neuromuscular blocking drugs.
What is the mechanism of action of AchE inhibitors?
Inhibition of acetylcholinesterase increases acetylcholine availability
This allows acetylcholine to bind to alpha subunits at the neuromuscular junction.
What is the ceiling effect in NMBD reversal agents?
They will not work with deep neuromuscular blockade
For example, Neostigmine has a maximum effective dose of 40 to 70 µg/kg.
What are the pharmacokinetics of Edrophonium?
- Dose: 0.5 to 1 mg/kg
- Onset of Action (OOA): 1 to 2 minutes
- Duration of Action (DOA): 5 to 15 minutes
It is rapidly effective due to its short action.
What are common side effects of NMBD reversal agents?
- Bradycardia
- Dysrhythmias
- Bronchoconstriction
- Increased salivation
- Miosis
These side effects arise from increased nicotinic/muscarinic activity.
How can side effects of NMBD reversal agents be prevented?
By administering anti-cholinergic/anti-muscarinic agents
Examples include Atropine and Glycopyrrolate.
What is a sign of persistent neuromuscular blockade?
Acetylcholinesterase is maximally inhibited
No further anticholinesterase is effective.
What factors influence NMBD reversal?
- Intensity of block
- Type of NMBD used
- Continued volatile anesthetic
- Choice of reversal drug
- Patient conditions
Conditions include metabolic acidosis, respiratory acidosis, and hypothermia.
What is Sugammadex?
A selective relaxant-binding agent used for NMBD reversal
It encapsulates free neuromuscular blocking drugs in plasma.
What are the pharmacokinetics of Sugammadex?
- Major route of elimination: Urine
- 70% eliminated in 6 hours
- 90% eliminated in 24 hours
- Elimination half-life: 2 hours
Renal impairment is a contraindication.
What is the recommended dose of Sugammadex for extreme block?
8 to 16 mg/kg
This dose helps achieve recovery of TOFR 0.9 from T2 twitch.
What are cautions associated with Sugammadex?
- Binds with progesterone (affecting oral contraceptives)
- Displaces NMBD from Sugammadex
- Caution in patients with coagulopathy/bleeding
Lower doses may lead to recurarization.
What are the signs and symptoms of recurarization?
- Decreased oxygen saturation
- Unresponsive patient
- Floppy appearance
- Ineffective abdominal and intercostal activity
These symptoms indicate a need for urgent intervention.
What is the treatment goal for recurarization?
Treat urgently and aggressively
This includes re-sedating the patient and administering additional reversal agents.
