Inhaled Anesthetics, NMBD Flashcards
Halothane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure
B:G = 2.54
MAC = 0.75%
Vapor Pressure = 243 torr
Enflurane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure
B:G = 1.90
MAC = 1.63%
Vapor Pressure = 175 torr
Isoflurane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure
B:G = 1.46
MAC = 1.17%
Vapor Pressure = 238 torr
What is MAC awake, MAC asleep, and MAC Bar of Isoflurane on a 35yo pt?
MAC Awake (0.3-0.5%): 0.351-0.585
MAC asleep (1.3%): 1.521
MAC bar (1.7-2%): 1.989-2.34
Nitrous Oxide
Blood:Gas Partition Coefficient
MAC
B:G = 0.46
MAC = 104%
Desflurane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure
B:G = 0.42
MAC = 6.6%
Vapor Pressure = 669 torr
What is MAC awake, MAC asleep, and MAC Bar of Desflueane on a 35yo pt?
MAC awake (0.3-0.5%): 1.98-3.3
MAC Asleep (1.3%): 8.58
MAC bar (1.7-2%): 11.22 - 13.2
Sevoflurane
Blood:Gas Partition Coefficient
MAC
Vapor Pressure
B:G = 0.69
MAC = 1.8%
Vapor Pressure = 157 torr
What is MAC awake, MAC asleep, and MAC Bar of Sevoflurane on a 35yo pt?
MAC awake (0.3-0.5%): 0.54 - 0.9
MAC asleep (1.3%): 2.34
MAC bar (1.7-2%): 3.06 - 3.6
1 Hz/second decreasing to 0.1 Hz q 10 seconds
Single Twitch
3 short bursts followed by 3 short bursts
Uses 50 Hz
Double Burst
4 stimuli at 2 Hz in ½ second
Train of Four
Very rapid, 50 Hz for 5 seconds – Continuous
Tetanic Stimulation
Single twitch 3 seconds after tetanic stimulation
Post-Tetanic Stimulation
Succinylcholine:
Dose
Onset
Duration
1 - 1.5 mg /kg IV
Onset - 30 to 60 seconds
Duration - 3 to 5 minutes
Lower Dibucaine # indicates what?
Prolonged Succinylcholine effects - No butyrylcholinesterase
High Dibucaine # indicates what?
Normal response to Succinylcholine
Dantrolene
Use
Dose
Max dose
Malignant Hyperthermia
2 mg/kg IV
Max dose 10 mg/kg IV
MACawake
0.3-0.5 MAC
MAC-BAR
1.7-2.0 MAC
For each decade above 50 years old, MAC decreases by..
6%
Pancuronium (Pavulon)
Intubating Dose:
Onset:
Duration:
Short or long-acting?
Intubating Dose: 0.1 mg/kg
Onset: 3-5 mins
Duration: 60-90 mins
Most common long-acting NMBD
What are the four intermediate-acting NMBDs?
Vecuronium
Rocuronium
Cisatracurium
Atracurium
Vecuronium (Norcuron)
Intubating Dose:
Onset:
Duration:
Intubating Dose: 0.1 mg/kg
Onset: 3-5 mins
Duration: 20-35 mins
Rocuronium (Zemuron)
Intubating Dose:
Onset:
Duration:
Intubating Dose: 0.6 mg/kg or 1.2 mg/kg
Onset: 3-5 mins; 1-2 mins with a larger dose
Duration: 20-35 mins
Cisatracurium (Nimbex)
Intubating Dose:
Onset:
Duration:
Intubating Dose: 0.1 mg/kg
Onset: 3-5 mins
Duration: 20-35 mins
Mivacurium (Mivacron)
Intubating Dose:
Onset:
Duration:
Intubating Dose: 0.15 mg/kg
Onset: 2-3 mins
Duration: 12-20 mins
Not used much anymore - “move-a-curium”
What muscle are the best indicators of diaphragmatic and laryngeal neuromuscular blockade?
Orbicularis Oculi & Corrugator Supercilli (Facial nerve)
What muscle is most resistant to neuromuscular blockade?
Diaphragm
What muscle is the gold standard for determination of NMB recovery?
Adductor Pollicis (ulnar nerve)
What four factors determine how much a muscle is subject to neuromuscular blockade?
- # of presynaptic ACh vesicles
- # of postsynaptic ACh receptors
- Blood flow to muscle
- NMB potency
Faster onset of neuromuscular blockade to a muscle means that that muscle experiences a ____ recovery.
Slower
