Neuromuscular Reversal Agents + Monitoring

Question 1

Acetylcholinesterase rapidly hydrolyzes

Answer 1

Ach

Question 2

AchE inhibitors

Answer 2

antagonize the residual effects of NMBD

Accelerate recovery from non-depolarizing drugs

Question 3

AchE drugs include

Answer 3

neostigime
edrophonium
pyridostigmine

Question 4

What AchE has a ceiling effect?

Answer 4

neostigimine

Question 5

AchE inhibitors cause a build up of Ach in

Answer 5

NMJ

Question 6

Once you’ve hit ceiling effect

Answer 6

max block depth that can be antagonized corresponds to return of fourth twitch in TOF
Cannot antagonize profound or deep levels of blockade
Administering more inhibitor may be detrimental

Question 7

Antagonism of NMBD depends on

Answer 7

depth of blockade when reversal is attempted
inhibitor chosen
dose
rate of spontaneous clear of NMBD
choice and depth of anesthesia

Question 8

Max Effective DOse of Neostigmine

Answer 8

0.06-0.08mg/kg

Question 9

Max effective Dose of Edrophonium

Answer 9

1.0-1.5 mg.kg

Question 10

Cardiovascular Side effects of Ach Inhibitor

Answer 10

muscarinic effects must be blocked by anticholinergic

Question 11

Dose of Glycopyrrolate

Answer 11

0.01-0.005 mcg/kg

Question 12

Dose of Atropine

Answer 12

0.007-0.01mcg/kg

Question 13

Pulmonary side effects of Ach Inhibitor

Answer 13

bronchoconstriction
increased airway secretions
increased salivation

Question 14

GI side effects of Ach Inhibitor

Answer 14

Increased bowel motilite

No effect on incidence of PONV

Question 15

Sugammadex

Answer 15

modified gamma-cyclogextrin

reversal of shallow and profound aminosteroid-induced blockade

Question 16

Sugammadex is

Answer 16

selective relaxant-binding

no effect on acetylcholinesterase

Question 17

Dosing of Sugammadex

Answer 17

TOF> 2: 2mg/kg
TOF 1-2 4 mg/kg
TOF 0: 8-16 mg/kg

Question 18

Sugammadex doesnt work against

Answer 18

succinylcholine

benzlisoquinoliniums

Question 19

Side effects of Sugammadex

Answer 19

possible allergic reactions and bleeding

Question 20

Onset of relaxation

Answer 20

eye muscles > extremities> trunk> abdominal muscles> diaphragm
b/c blood flow is greatest to the head neck and diaphargm

Question 21

TOF

Answer 21

four separate stimuli every 0.5 seconds at 2Hz

Question 22

To ensure reversal of NMBD

Answer 22

TOF > 0.9

Question 23

TOF less then 0.9 is associated with

Answer 23

difficulty speaking
difficulty swallowing
visual disturbances
aspiration risk

Question 24

AchE inhibitor side-effects

Answer 24

bronchoconstriction (increased airway restriction, increased salivation)
increased bowel motility
muscarinic effects must be blocked by antocholinergic

Question 25

Why do we monitor NMB?

Answer 25

proper administration of NMBD is essential to surgery (under or over dosing)

Question 26

Contraction of adductor muscle of thumb is

Answer 26

preferred method of determining level of blockade

Question 27

Facial nerve monitoring involves stimulation of

Answer 27

orbicularis oculi muscle (facial nerve)

Question 28

Blood flow greatest to head and neck and diaphragm

Answer 28

onset measured in facial nerves | recovery best measured in the hand

Question 29

Onset of paralysis in non-depolarizing agent there is a decrease in

Answer 29

in twitch response between T1-T4 (fade)

Question 30

TOF can aid in determining degree of block

Answer 30

Most sensitive between 70-100% paralysis

Question 31

T4

Answer 31

75-80%

Question 32

T3

Answer 32

80-85%

Question 33

T2-4

Answer 33

90-95%

Question 34

Tetany

Answer 34

continous electrical stimulation for 5 seconds at 50-100Hz reliable for detecting fade sustained contraction w/o fade, significant paralysis unlikely

Question 35

Posttetanic count-

Answer 35

tetany followed in 3 seconds by single twitch stimulations | higher the count (>8) the less intense the block

Question 36

Single Twitch

Answer 36

single twitch at 0.1-1Hz for 0.1-0.2ms | determine whether 100% paralysis is present

Question 37

Double Burst Suppression

Answer 37

Seems to improve ability to detect residual paralysis | evaluating 2 rather than 4 twitches facilitates detection

Question 38

Not reliable indictor for endotracheal extubation

Answer 38

5 second head life toF ratio <0.6 generate peak negative inspiratory pressure 20-30 cmH20