NMBD Reversal Agents (4) Flashcards
What is another name for neuromuscular monitoring?
Acceleromyography
What is the most common location nerve and muscles are monitored?
- Hand
- Adductor pollicis
- Ulnar nerve
List NMBD reversal agents:
- Edrophonium
- Neostigmine
- Sugammadex
What anticholinergic drugs can be used for NMBD reversal?
- Atropine sulfate
- Glycopyrrolate
Why isnt physostigmine used for NMBD reversal?
Crosses BBB
What is the MOA of NMBD reversal agents? What type of antagonism do they create?
Acetylcholinesterase inhibitor (cholinergic agents)
Competitive antagonism
What does it mean that NMBD reversal agents have a ceiling effect?
They will not work with deep blockade
What is the dose for neostigmine for reversal?
40-70mcg/kg
MAX 5mg
What 5 things does reversal of NMBD depend on?
- Depth of the NM Block
- AchE Inhibitor choice
- Dose administered
- Rate of plasma clearance of NMBD
- Anesthesia agent choice and depth (Postoperative Residual NM Blockade)
What is the dose, onset, and duration of sugammadex?
2-16 mg/kg
onset: 1-4 min
duration: 1.5-3 hours
What is the drug classification of Sugammadex?
Gamma cyclodextrin
What is the dose, onset, duration and anticholinergic dose for neostigmine?
Dose: 40-70mcg/kg (0.04-0.07mg/kg)
Onset: 5-10 min
Duration: 60min
Anticholinergic: Glycopyrrolate 0.2mg/mg of neostigmine
What med do we give first before edrophonium?
Atropine (anticholinergic) so the HR increases first then give edrophonium to counter act the anticholinergic
What is the dose, onset, and duration of edrophonium?
Dose: 0.5-1 mg/kg
onset: 1-2 min
duration: 5-15 min
What dose of glyco is given with neostigmine?
0.2mg glyco/ mg of neostigmine
5mL
5mL
How is neostigmine excreted?
Renal excretion 50%
How is pyridostigmine and edrophonium excreted?
75% Renal excretion
How does chronic renal failure affect pharmacokinetics of NMBS reversal agents?
Decreases plasma clearance and prolongs action
What is the hepatic clearance of NMBD reversal agents if no renal function?
30-50%
What are some NMBD reversal CV side effects?
CV: Bradycardia, dysrhythmias, asystole, ↓SVR
What are NMBD reversal pulmonary side effects?
Pulmonary: Bronchoconstriction, increased airway resistance, increased salivation
What are GI side effects of NMB reversal drugs?
GI: Hyperperistalsis, enhanced gastric fluid secretion, PONV