NMB Monitoring Flashcards
What is TOF?
Train of Four
What two Hz levels are usually used for tetany?
50 Hz and 100 Hz
What is most common NMBM sites?
Unlar nerve
What is correct way to orient cathodes when placing them on body?
Red closest to heart, black most distal
Name 2 other NMBM sites other than ulnar nerve?
Facial nerve on side of face between ear and eye
Posterior tibial nerve on inside of ankle near medial malleolous
What is unique about facial nerve placement?
Red cathode is placed more superior (away from heart) and black more inferior (closer to heart)
What is motion that is observed when checking facial nerve using NMBM?
Eyebrow will twitch
How many twitches are seen when at least 75% of receptors are blocked?
3 twitches
What percent of receptors are blocked when 4 twitches are observed?
0-75% of receptors
What percent of receptors are blocked when 2 twitches are seen?
80%
How many twitches would you expect when 90% of receptors are blocked?
1 twitch
Explain what you would observe when 100% of receptors are blocked
0 twitches and with no tetany
How many twitches must be observed before you can give reversals?
At least 1
What drug produces fasiculations?
Succinycholine
What are fasiculations?
Uncontrolled muscle twitches throughout entire body seen under the skin
What is the unit of measure on NMB stimulator?
mA
Which NMB agent has shortest duration of action?
Succinylcholine
What NMB agent has longest duration?
Pancuronium
What is a non depolarizing NMB agent?
Roc, Vec, Nimbex, Panc
What is the depolarizing NMB agent used in anesthesia?
Succinylcholine
Define sensory threshold
Threshold at which when pt is awake, produces a facial reaction when NMB monitor is turned on
What is the motor threshold?
Threshold at which produces a motor twitch from NMB stimulation after pt has gone to sleep but before muscle relaxant has been administered
How many mA should be administered to determine sensory threshold?
4-5 mA
How many mA are administerd when determining motor threshold?
15-20 mA
What is the supermaximal stimulus?
25 mA above motor threshold
What physiologic significant variable effects stimulation thresholds?
Temperature
When the nerve stimulator is placed on the ulnar nerve, the actions of which muscle(s) is/are being monitored?
Flexor Carpi Ulnaris and Adductor Pollicis
What causes prolonged neuromuscular blockade following administration of succinycholine?
Pseudocholinesterase deficiancy
How do you offset the fasciculations associated with succinycholine?
5 mg Rocuronium
List order of muscles affected by a neuromuscular blockade?
– Laryngeal adductors
– Diaphragm
– Orbicularis oculi
– Rectus abdominus
– Adductor pollicis
