NMB Monitoring

Question 1

What is TOF?

Answer 1

Train of Four

Question 2

What two Hz levels are usually used for tetany?

Answer 2

50 Hz and 100 Hz

Question 3

What is most common NMBM sites?

Answer 3

Unlar nerve

Question 4

What is correct way to orient cathodes when placing them on body?

Answer 4

Red closest to heart, black most distal

Question 5

Name 2 other NMBM sites other than ulnar nerve?

Answer 5

Facial nerve on side of face between ear and eye

Posterior tibial nerve on inside of ankle near medial malleolous

Question 6

What is unique about facial nerve placement?

Answer 6

Red cathode is placed more superior (away from heart) and black more inferior (closer to heart)

Question 7

What is motion that is observed when checking facial nerve using NMBM?

Answer 7

Eyebrow will twitch

Question 8

How many twitches are seen when at least 75% of receptors are blocked?

Answer 8

3 twitches

Question 9

What percent of receptors are blocked when 4 twitches are observed?

Answer 9

0-75% of receptors

Question 10

What percent of receptors are blocked when 2 twitches are seen?

Answer 10

80%

Question 11

How many twitches would you expect when 90% of receptors are blocked?

Answer 11

1 twitch

Question 12

Explain what you would observe when 100% of receptors are blocked

Answer 12

0 twitches and with no tetany

Question 13

How many twitches must be observed before you can give reversals?

Answer 13

At least 1

Question 14

What drug produces fasiculations?

Answer 14

Succinycholine

Question 15

What are fasiculations?

Answer 15

Uncontrolled muscle twitches throughout entire body seen under the skin

Question 16

What is the unit of measure on NMB stimulator?

Answer 16

mA

Question 17

Which NMB agent has shortest duration of action?

Answer 17

Succinylcholine

Question 18

What NMB agent has longest duration?

Answer 18

Pancuronium

Question 19

What is a non depolarizing NMB agent?

Answer 19

Roc, Vec, Nimbex, Panc

Question 20

What is the depolarizing NMB agent used in anesthesia?

Answer 20

Succinylcholine

Question 21

Define sensory threshold

Answer 21

Threshold at which when pt is awake, produces a facial reaction when NMB monitor is turned on

Question 22

What is the motor threshold?

Answer 22

Threshold at which produces a motor twitch from NMB stimulation after pt has gone to sleep but before muscle relaxant has been administered

Question 23

How many mA should be administered to determine sensory threshold?

Answer 23

4-5 mA

Question 24

How many mA are administerd when determining motor threshold?

Answer 24

15-20 mA

Question 25

What is the supermaximal stimulus?

Answer 25

25 mA above motor threshold

Question 26

What physiologic significant variable effects stimulation thresholds?

Answer 26

Temperature

Question 27

When the nerve stimulator is placed on the ulnar nerve, the actions of which muscle(s) is/are being monitored?

Answer 27

Flexor Carpi Ulnaris and Adductor Pollicis

Question 28

What causes prolonged neuromuscular blockade following administration of succinycholine?

Answer 28

Pseudocholinesterase deficiancy

Question 29

How do you offset the fasciculations associated with succinycholine?

Answer 29

5 mg Rocuronium

Question 30

List order of muscles affected by a neuromuscular blockade?

Answer 30

– Laryngeal adductors

– Diaphragm

– Orbicularis oculi

– Rectus abdominus

– Adductor pollicis