Neuromuscular Blockers

Question 1

Succs: Dose / Onset / Duration

Answer 1

Dose: 1mg/kg (Actual Body Weight!!)
Onset: 30-60 secs.
Duration: 3-5 min.

Question 2

Succs: Metabolism

Answer 2

-Hydrolyzed by Butyrylcholinesterase (Plasma Cholinesterase)

-Synthesized by Liver

-Metabolites:
Succinylmonocholine and Choline

Question 3

Succs: Side Effects

Answer 3

Hyperkalemia/Cardiac Dysrthythmias
Myoglobinuria
Myalgia
Masseter Spasm
Increased Intra-gastric pressure
Increased Intra-ocular pressure
Increased Inter-cranial pressure

Question 4

Succs: Would you recommend giving consecutive doses (i.e 5 mins apart). Why or Why not?

Answer 4

No. Cardiac Dysrhythmias can occur with consecutive doses. Usually occur on 2nd dose.

Question 5

Succs: T/F? we want to give Succs. to children since they are less likely to experience side effects? Why/Why not?

Answer 5

False. Avoid Succs. in children due to unpredictable reaction (usually first surgery so unsure of MH).
Also Myoglobinuria. This also contributes to hyperkalemia.

Question 6

ABCD’s of MH

Answer 6

Agents: stop all triggering agents
Admin: non-triggering anesth.
Ask for help
Ask for MH cart
B: Breathing (hyperventilating. with 100% O2
C: Cooling procedures if patients > 102.2
D: Dantrolene (cont. rapid IVP)

Question 7

Dantrolene: Dose / Class of Drug

Answer 7

2mg/kg IV
Repeat doses until symptoms subside or 10mg/kg IV

CCB

Question 8

Pancuronium (Pavilion): Dose / Onset / Duration

Answer 8

Intubating dose: 0.1mg/kg
Onset: 3-5 mins.
Duration: 60-90 mins.

Question 9

Pancuronium (Pavilion): Class Chemical & Short/Interm./Long acting?

Answer 9

Long Acting Aminosteriod

Question 10

Pancuronium (Pavilion): Metabolism

Answer 10

Mainly metabolized at liver or kidney
Cautious with Renal and Liver failure patients.

Question 11

What are the intermediate acting NMBD

Answer 11

Vecuronium
Rocuronium
Cisatracurium
Atracurium

Question 12

Vecuronium (Norcuron): Class & Chemical

Answer 12

Intermediate Acting; Aminosteroid

Question 13

Vecuronium (Norcuron): Doses

Answer 13

Intubating Dose: 0.1 mg/kg

Onset: 3-5 minutes

Duration: 20-35 minutes

Question 14

Vecuronium (Norcuron): Metabolism

Answer 14

Hepatic metabolism –>Principle organ of elimination, so caution in Liver patients

Renal excretion –> Approx 30% appears unchanged (*70% metabolized in liver)

Caution with Renal dysfunction