Neuromuscular Blockers and Reversals

Question 1

what is Anectine

Answer 1

Succinlycholine

Question 2

succinylcholine

class/ category

Answer 2

Depolarizing neuromuscular blocker

Question 3

Succinylcholine

uses

Answer 3

• Intubation
• rapid sequence induction and intubation
• treatment of laryngospasm

Question 4

succinylcholine

MOA

Answer 4

Postsynaptic Nicotinic M, Acetylcholine agonist

Question 5

succinlycholine

Doses: intubation and RSI

Answer 5

Intubation: 1 mg/kg TBW

RSI: 1.5 mg/kg TBW

Question 6

succinlycholine

onest, peak, duration, ED95

Answer 6

Onset: 30-60 sec

Peak: 60 sec

Duration: 5-10 min

ED95: 0.3 mg/kg

Question 7

succinlycholine

meabolism and active metabolite

Answer 7

Metabolism: Plasma/pseudo/butryl-cholinesterase

Active metabolite: Succinylmonocholine (weakly active, renally excreted)

Question 8

succinlycholine

CV effects

Answer 8

• Arrhythmias – Bradycardia, junctional rhythm, asystole (most common in pediatrics; likely with repeat dosing); ventricular arrhythmias with stimulation
  -Sinus arrest from cardiac M2 stimulation
• ↑ HR, ↑ BP

Question 9

succinlycholine

CNS effects

Answer 9

• ↑ ICP – Preventable with adequate anesthesia and defasciculating dose
• ↑ CBF
• ↑ IOP – Ensure adequate anesthesia

Question 10

succinlycholine

GI effects

Answer 10

↑ intragastric pressure (does not exceed barrier pressure), ↑ LES pressure –** Does not** increase risk for aspiration

Question 11

what electrolyte does succinlycholine increase and by how much?

Answer 11

Increases K+ release by 0.5-1 mEq/L in healthy individuals, may be exaggerated by comorbid disease/illness

Question 12

what muscle spasm may indicate MH?

Answer 12

Masseter muscle spasm – May indicate MH or inadequate dose

Question 13

T/F succinlycholine can cause fasciculations

Answer 13

TRUE

Question 14

what could occur 1-2 days post op, what population is it most common with?

Answer 14

Myalgias for 1-2 days postoperatively – Most common in young, ambulatory, females; lower Succinylcholine doses

Question 15

succinlycholine ay cause myoglobinurina? T/F
and especially with which population?

Answer 15

TRUE

peds

Question 16

succinlycholine may release this and trigger for what two things?

Answer 16

• Histamine release
• Potential trigger for anaphylaxis
• MH trigger – May present as masseter muscle spasm

Question 17

succinlycholine contraindications

Answer 17

• Personal or familial history of MH;
• elevated preoperative K+ level
• ≥ 24 hours after injury/disease process associated with immature, extrajunctional ACh receptors (risk for exaggerated K+ release and life-threatening hyperkalemia)

Question 18

What is the recommendation for succinlychline in regards to open eye injury

Answer 18

Relative contraindications: Open eye injury (anterior chamber)

Question 19

succinylcholine black box warning

Answer 19

Acute rhabdomyolysis with hyperkalemia → ventricular dysrhythmias, cardiac arrest, and death (in children with undiagnosed skeletal muscle myopathy such as Duchenne muscular dystrophy) – May be used in emergency intubation or instances of necessity to immediately secure airway

Question 20

Is succinylcholine used routinely in pediatrics?

Answer 20

NO, Not recommended for routine pediatric use

Question 21

Which patient population has a delayed on set with succinylcholine?

Answer 21

Onset delayed in elderly

Question 22

T/F-May use in patients with renal failure who have a normal K+ and no uremic neuropathy?

Answer 22

TRUE

Question 23

is a defasciculating dose of NDNMB relabile to prevent succinlycholine side effects?

Answer 23

Defasciculating dose of NDNMB is unreliable to prevent side effects of Succinylcholine

Question 24

what is a defasciculating dose of succinlycholine?

Answer 24

If administering a defasciculating dose of NDNMB, increase dose to 1.5-2 mg/kg

Question 25

Does succinylcholine have a reversal agent?

Answer 25

No reversal agent – not reversible with Suggamadex