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Anesthesia Basics > NMB Monitoring > Flashcards

NMB Monitoring Flashcards

1
Q

Reasons to monitor

A

Inter pt variability in dosing, intub timing, titration to effect, readiness of reversal, adequacy of reversal, differentiates type of block, early recog of pseudocholinesterase def

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2
Q

When to monitor

A

Muscle relaxant used, hypothermia, neuro/renal/hepatic disease, post op power, gtt

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3
Q

1 hertz =

A

1 cycle/sec

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4
Q

10 hz=
0.1 hz=
Range

A

10 stim per sec
1 stim per 10 sec
0.1-100 hz

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5
Q

Stim which muscles: ulnar nerve, facial nerve

A

Adductor pollicis, orbicularis oculi

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6
Q

3 non main nerves that can be used

A

Median, post tibia, common peroneal

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7
Q

Placing of electrodes on ulnar nerve

A
  • electrode 1 cm proximal to wrist crease. + electrode 2-5 cm of distal one.
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8
Q

Most sensitive to most resistant muscles

A

Extraocular, pharyngeal, masseter, adductor pollicis, abd rectus, orbicularis, diaphragm, VC

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9
Q

__ __ response reflect NMB extent of diaphragm better than response of __ __

A

Orbicularis > adductor pollicis

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10
Q

Pro and con to adductor pollicis monitoring

A

Diaphragm can still move even if no twitch on TOF. But no block left in diaphragm if adductor pollicis is recovered.

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11
Q

Single twitch stim

Common settings, use

A

0.1-1 hz. 0.1 frequency most common. Not diff between depol/nondepol. Assess baseline strength before NMB given

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12
Q

Does presence of full twitch height guarantee recovery from NMB

A

No

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13
Q

TOF

What it delivers

A

4 pulses of equal intensity of 2/sec (0.5 sec) to 2 hz freq

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14
Q

TOF

Detects which phase of block

A

Phase 2

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15
Q

TOF
Ratio when no NMB given
What happens w NDMR
What happens w depolarizing

A
  1. Fade and ratio decreases. 1 ratio remains, amplitude decreases
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16
Q

TOF pros

Shouldn’t be repeated more frequently than what

A

Less painful and dont need control value. 12 sec

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17
Q

Tectanic stim

Settings

A

50-200 hz for 5 sec

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18
Q

Tetanic stim

When sustained, not sustained

A

Sustained- normal nm transmission and depolarizing block.

Not- non depolarizing, phase 2

19
Q

Post tetanic potentiation
What it is
Related to what

A

Ability during nondep block to inc evoked response to a seubsequent twitch. Rel to inc in ach mobilization after stim

20
Q

How to post tetanic count

A

50 hz 5 sec. then 1 hz 3 seconds after tetanic stim

21
Q

Post tetanic count values

A

1- intense block
3- less intense
Inc during surgical block

22
Q

Post tetanic stim when it appears:
Panc for intubation before TOF?
Vec/roc/atra before TOF

A

35 min

10 min

23
Q

PTC uses

A

Ensure coughing from intub elim (zero PTC), NDMR gtt, when no single twitch or TOF

24
Q

Double burst stim

What it delivers

A

2 train of 3 impulses at 50 hz separated by 750 ms

25
Q

Double burst stim
Evaluate what
Non paralyzed vs paralyzed

A

Ratio of 2nd to 1st response. Non par: equal strength. Par: 2nd response weaker

26
Q

Double burst stim
TOF less than what hard to detect
Superior to what
Easier to feel what

A

0.3. Sup to TOF tactile eval, easier to feel fade in dbs than TOF

27
Q

Phases of block

A

Pre block. Intense block (can intubate, no response). Moderate block (surgical). Recovery

28
Q

Intense nm block phase

Occurs when, what its called, varies based on

A

3-6 min after med. no response period. Length varies based on agent, dose, and pt sensitivity

29
Q

Moderate/surgical block

Begins when

A

1st response to TOF

30
Q 
TOF- % block- clinical 
None- 
1
2
3
4
A 
100, ett 
90, surgery 
80-90
75-80, needs reversal 
0-75, recovery
31
Q

When antagonism of block shouldn’t occur

A

Before at least 2, preferably 3 responses to TOF

32
Q

When dbs most useful

A

After reversal

33
Q

How many TOF twitches to begin recovery phase, ratio, or what

A

4 twitches, 0.4 or lift head/arm

34
Q

TOF ratio 0.6 pt can do what

0.75

A

Lift head 3 sec, open eyes protrude tongue

Cough, lift head 5 sec, grip weak

35
Q

Recovery phase

TOF ratio of what= return of nm function adequate

A

> 0.75

36
Q

Phase 2 block

An abn response to what in who. Manifests as what two things

A

Depolarizing agent, genetically abn individual.

Post tetanic fade and prolonged block

37
Q

Depol nm block

Phase 1: 3

A

Response typical, no fade to TOF or tetanic, no post tetanic potentiation

38
Q

Phase 2 block with depolarizer: seen in who. Charac by what

A

Plasma cholinesterase def or normal pts w sux. Fade in TOF/tetanic stim, post tetanic potentiation

39
Q

Phase 2

Reversal occurs in __ min 50% ppl. Advised recovery time. When can happen after this

A

10-15 min

20-25 min. Anticholinesterase reversal

40
Q

receptors occupied with: TV, twitch height, tetanic stim 30 hz

A

80.

80-75 for last two

41
Q

receptors occupied in VC, TOF, Tetanic stim 100hz, ins force, head lift 5 sec

A

75-80, 75-80, 50, 50, 33

42
Q

TOF or __ hz when pt unconscious but not relaxed

A

0.1

43
Q

After sux for intub when twitch returns.

A

4-8 min

Anesthesia Basics (10 decks)

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