Neuromuscular blockers 3 Flashcards
Identify the patient at the HIGHEST risk for developing postoperative myalgia following succinylcholine.
a. 6-year-old boy for strabismus correction
b. 24-year-old female for umbilical hernia repair
c. 35-year-old pregnant patient for appendectomy
d. 86-year-old-male for total hip arthroplasty
b. 24 year old female for umbilical hernia repair
Succinylcholine is a well-recognized cause of _______________ that may persist up to 24-48 hours.
postoperative myalgia
Patients with the highest risk of myalgia following succinylcholine include
young adults undergoing ambulatory surgery (women>men) and those that do not routinely engage in strenuous activity
When using a defasciculating dose of a nondepolarizer, the dose of succinylcholine should be increased to
1.5-2.0 mg/kg
Methods of reducing the incidence of myalgia include
pretreatment with a nondepolarizing neuromuscular blocker
NSAIDs
lidocaine
using a higher dose rather than a lower dose of succinylcholine
Patients that should probably not receive a defasciculation dose of a nondepolarizer include
those with pre-existing skeletal muscle weakness such as those with myasthenia gravis
Myalgia manifests as
soreness in the neck, shoulders, subcostal region, upper abdominal muscles, and trunk muscles
Patients who have the lowest risk of succinylcholine induced myalgias include
children
the elderly
pregnant patients
How early should a nondepolarizer be administered prior to giving succinylcholine?
3-5 minutes
What doses of nondepolarizers can be used to prevent fasciculations?
rocuronium 2 mg
1.5 mg atracurium
0.3 mg vecuronium
Why does the dose of succinylcholine need to be increased if using a nondepolarizer drug?
the nondepolarizer will competitively antagonize the nicotinic receptor so more succinylcholine must be given to overwhelm the nondepolarizer’s effect
Which diseases are associated with hyperkalemia following succinylcholine administration? (select 3)
a. hyperkalemic periodic paralysis
b. multiple sclerosis
c. hypokalemic periodic paralysis
d. myotonic dystrophy
e. Huntington chorea
f. Guillain-barre
a. hyperkalemic periodic paralysis
b. multiple sclerosis
f. Guillain-Barre
Select conditions that increase the risk of succinylcholine-induced hyperkalemia include:
Guillain-Barre
Hyperkalemic periodic paralysis
Malignant hyperthermia
multiple sclerosis
Up-regulation of acetylcholine receptors
Select conditions that increase sensitivity to nondepolarizing neuromuscular blockers include
Guillain-Barre
Huntington chorea
multiple sclerosis
myasthenia gravis
What is Duchenne’s muscular dystrophy response to succinylcholine?
hyperkalemia + rhabdomyolysis
What is Duchenne’s muscular dystrophy response to nondepolarizing drugs?
sensitive
What is Guillain-Barre’s response to succinylcholine?
hyperkalemia
What is Guillain-Barre’s response to non-depolarizer drugs?
sensitive
What is MS’s response to succinylcholine
hyperkalemia
What is MS’s response to nondepolarizer drugs?
sensitive
What is ALS’ response to succinylcholine?
hyperkalemia
What is ALS’ response to nondepolarizer drugs?
sensitive
What is upregulation of AChRs response to succinylcholine?
hyperkalemia
What is upregulation of AChRs response to nondepolarizers?
resistant or normal- depends on timing of injury
What is Charcot-Marie-Tooth response to succinylcholine?
hyperkalemia
What is Charcot-Marie Tooth response to nondepolarizers?
normal
What is hyperkalemic periodic paralysis response to succinylcholine?
hyperkalemia
What is hyperkalemic periodic paralysis response to non-depolarizers?
normal
What is hypokalemic periodic paralysis response to succinylcholine?
MH???
What is hypokalemic periodic paralysis response to nondepolarizers?
normal
What is malignant hyperthermias response to succinylcholine?
MH
What is MH’s response to nondepolarizer drugs?
normal
What is myotonic dystrophy’s response to succinylcholine?
muscle contractures- potential problem with airway management
What is myotonic dystrophy’s response to nondepolarizers?
normal or sensitive
What is Huntington’s response to succinylcholine?
sensitive
What is Huntington’s response to nondepolarizers?
sensitive
What is myasthenia gravis’ response to succinylcholine?
resistant
What is myasthenia gravis’ response to nondepolarizers?
sensitive
Rank the nondepolarizing neuromuscular blockers in terms of potency (most to least):
cisatracurium, pancuronium, atracurium, rocuronium
In the context of neuromuscular blockers, the ED95 is the dose at which there’s
a 95% decrease in twitch hheight
The dose required to provide optimal conditions for tracheal intubation is
~2-3 times the ED95
The higher the ED95, the __________ the potency, and the ______________ the onset
lower; faster
What is the intubating dose of mivacurium?
0.15 mg/kg
What is the onset of mivacurium?
3.3 minutes
What is the duration of mivacurium?
17 minutes
What is the intubating dose of cisatracurium?
0.1 mg/kg
What is the onset of cisatracurium?
5.2 minutes
What is the duration of cisatracurium?
45 minutes
What is the intubating dose of vecuronium?
0.1mg/kg
What is the onset of vecuronium?
2.4 minutes
What is the duration of vecuronium?
45 minutes
What is the intubating dose of atracurium?
0.5 mg/kg
What is the onset of atracurium?
3.2 minutes
What is the duration of atracurium?
45 minutes
What is the dose of rocuronium?
0.6 mg/kg
What is the onset of rocuronium?
1.7 minutes
What is the duration of rocuronium?
35 minutes
What is the dose of pancuronium?
0.08 mg/kg
What is the onset of pancuronium?
2.9 minutes
What is the duration of pancuronium?
85 minutes
