Neuromuscular monitoring Flashcards
1
Q
Neuromuscular blockade monitoring
A
- Supramaximal current 20 - 60 mAmps
- TOF = 2Hz. Can be repeated after 15 seconds
- Positive electrode (red) is placed proximally
- TOF ratio = fourth twitch amplitude compared to the first. Adequate reversal indicated by TOF ratio >0.9
- Fade is a feature of non-depolarizing neuromuscular blocking agents
- 4 twitches: <75% receptor blockade
- 3 twitches: 75% receptor blockade
- 2 twitches: 80% receptor blockade
- 1 twitch: 90% receptor blockade
- 0 twitches: 100% receptor blockade
- Double burst stimulation: Two 50Hz bursts of stimuli with 750ms interval between them, which are visualized as two separate muscle contractions. Improves visual detection of fade
- Post-tetanic count: 50Hz stimulus applied for 5s, followed by TOF. Used to assess deep neuromuscular block to give indication of time until 1st twitch returns
