Neuromuscular Blockade Monitoring

Question 0

What is important about electrode placement for NMB

Answer 0

1) The red electrode also known as the anode should be closer to the Heart
2) Maximum current density
3) minimal Current dispersion
4) Electrodes close to the nerve

Question 1

What unit of measure is used on the in NMB monitor?

Answer 1

Milliamp (mA)

Question 2

What is true of sensory threshold

Answer 2

1) Should be measured before induction with propofol
2) watch facial expression
3) should set the monitor to 5 mA

Question 3

What is true of motor threshold

Answer 3

1) Should be done after induction before the muscle relaxant is given
2) Watch for first motor response i.e. just a twitch
3) monitor at 15 mA

Question 4

What is true of supra-maximal Stimulus

Answer 4

Activate all Muscle fibers via the nerve serving that muscle Without stimulating the actual muscle fibers

Should not be greater than 40 mA

Question 5

What is the emperic setting

Answer 5

25 million above motor threshold

and again – do not set to greater than 40 mA

Question 6

Which relaxants and what doses should be used for thyroid surgery

Answer 6

Intubation: succinylcholine 1 mg/kg

Maintenance neuromuscular blockade (if needed): 5 mg increments
wait 4-6 minutes to test train of four, should be 2/4. at 40 mA
document.

Note:
you want to keep 2/4 twitches because you do not want the facial nerve to be paralyzed