Notes in 04 Neuromuscular Blockers

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Published	07/30/2024	When can NMBs be given?{{c1::Ventilation is established after GA administration}}
Published	07/30/2024	{{c1::3-5}} minutes after NMB is given, the anesthesiologist can now insert the blade of the laryngoscope and lift the jaw in order to expose the lary…
Published	07/30/2024	Give 3 uses of NMBs{{c1::To facilitate intubation of the tracheaTo facilitate mechanical ventilationTo optimize surgical conditions}}
Published	07/30/2024	Representative Depolarizing NMBs: {{c1::Succinylcholine}}Representative Non-depolarizing NMBs: {{c1::Rocuronium, Atracurium, Cis-atracurium}…
Published	07/30/2024	Succinylcholine also known as {{c1::suxamethonium or anectine}}
Published	07/30/2024	Succinylcholine binds to {{c1::Fast Na channels}}
Published	07/30/2024	Timeline of Succinylcholine Effects30 secs: {{c1::Transient Muscle Fasciculations beginning from the from the face going down to the}}90 secs: {{c1::M…
Published	07/30/2024	Succinylcholine is rapidly metabolized by {{c1::pseudocholinesterase}} into {{c2::succinylmonocholine}} in the circulation
Published	07/30/2024	VR1. {{c2::Hypothermia, Pregnancy, Liver Disease, Kidney Failure}}2. Succinylcholine duration of action {{c1::A}}
Published	07/30/2024	QC. Nondepolarizing inhibitors agents1. Phase 1 depolarization 2. Phase 2 depolarization{{c1::B}}
Published	07/30/2024	QC. Cholinesterase inhibitors agents1. Phase 1 depolarization 2. Phase 2 depolarization{{c1::A}}
Published	07/30/2024	QC. Echothiopate eye drops1. Cholinesterase inhibitors2. Nonndepolarizing inhibitors{{c1::A}}
Published	07/30/2024	T or FSuccinylcholine only binds to nicotinic receptors {{c1::False, also inhibit M receptors - causing irregular heart rhythm}}
Published	07/30/2024	Muscle fasciculations cause minute releases of {{c1::K+}} from the cells
Published	07/30/2024	Avoid using succinylcholine In patients with preexisting {{c1::hyperkalemia}}
Published	07/30/2024	Why avoid using succinylcholine in pt with spinal cord injury {{c1::Muscle denervation can have proliferation or upregulation of nicotinic recept…
Published	07/30/2024	MOA of increased intraocular pressure from succinylcholine {{c1::Tonic contraction of the extraocular muscles (EOMs)}}
Published	07/30/2024	Reason for decreased administration of succinylcholine in patients with gastroparesis  (delayed gastric emptying time){{c1::Can cause regurg…
Published	07/30/2024	Succinylcholine ADE:{{c1::HyperkalemiaMyalgia Malignant Hyperthermia Inc Intraocular PressureInc Intragastric PressureCardiac Arrhythmias::5…
Published	07/30/2024	Non-depolarizing NMB MOA: {{c1::COMPETITIVELY inhiits ACh for nicotinic receptors}}
Published	07/30/2024	Non-depolarizing NMB Prototype: {{c1::Tubocurarine}}
Published	07/30/2024	Two classifications of Non-depolarizing NMBs{{c1::Steroid derivativesIsoquinoline derivatives}}
Published	07/30/2024
Published	07/30/2024	Most commonly used non-depolarizing NMB clinically according to duration of action {{c1::Intermediate (20-50 min): Atracurium}}
Published	07/30/2024	First muscle to recover from paralysis after Non-depolarizing drug administration {{c1::Diaphragm}}
Published	07/30/2024	QC. NMBA-specific sensitivity of vocal cord muscles1. High 2. Low {{c1::B}}
Published	07/30/2024	QC. NMBA-specific sensitivity of Abdominal muscles1. High 2. Low {{c1::B}}
Published	07/30/2024	QC. NMBA-specific sensitivity of diaphragm muscles1. High 2. Low {{c1::B}}
Published	07/30/2024	Most sensitive muscle to NMBA {{c1::Pharyngeal muscles}}
Published	07/30/2024	Rocuronium propertiesStructure: {{c1::Steroid}}Onset: {{c1::3-5 mins}}Duration action: {{c1::20-50 mins}}Intermittent schedule to give maintenanc…
Published	07/30/2024	Atracurium and Cis-Atracurium Strucuture: {{c1::Isoquinoline}}Duration action: {{c1::20-50 mins}}Enzymatic metabolism: {{c1::Ester…
Published	07/30/2024	Atracurium triggers dose-dependent {{c1::Histamine}} release when given rapidly in large doses
Published	07/30/2024	Atracurium is contraindicated for these patients due to dose-dependent release of histamine due to large dose{{c1::History of asthma}}
Published	07/30/2024	T or FSimilar to atracurium, cis-atracurium can also cause dose-dependent realase of histamine {{c1::F}}
Published	07/30/2024	QC. Potency 1. Atracurium 2. Cis-atracurium {{c1::B}}
Published	07/30/2024	Laudanosine metabolite effects on CNS{{c1::Increase MAC - Precipitate seizure}}
Published	07/30/2024	Determine state that increase potency of NDMBTemperature: {{c1::Hypothermia}} Acid-base: {{c1::Acidosis }}Electrolyte: {{c1::Hypokalemia, Hy…
Published	07/30/2024	This can be one of the causes of post operative morbidity/mortality from NMBs{{c1::Inadequate diaphragm movement - respiratory failure}}
Published	07/30/2024	Most important clinical assessment to identify recovery from NMB {{c1::Return of spontaneous adequate respiratory effort}}
Published	07/30/2024	Visible sign from recovery of NMB{{c1::Visible chest rise}}
Published	07/30/2024	Voluntary actions that should be seen in recovery from NMB {{c1::Eye opening without diplopiaSustained head liftTongue protrution Pharyngeal…
Published	07/30/2024	Electrical stimulus with peripehral nerve stimulator for testing function after NMB administration could be in a form of:{{c1::Single twtich Trai…
Published	07/30/2024	How is train-of-four stimulation done?{{c1::Deliver four supramaximal stimuli every 0.5s}}
Published	07/30/2024	Intended response in TOF ratio with NMB use{{c1::Decrease until 4th response}}
Published	07/30/2024	Ideal ratio value of TOF {{c1::0.2}}
Published	07/30/2024	Idea TOF ratio score during reversal of NMB effect {{c1::> 0.9}}
Published	07/30/2024	Which nerve is targeted during TOF test with peripheral nerve stimulator?{{c1::Ulnar nerve to see adduction of finger (Adductor pollicis)}}
Published	07/30/2024	Which electrodes of peripheral nerve muscle device is placed at the medial aspect of forearm?{{c1::Positive and negative}}
Published	07/30/2024	QC. Equally reduced T1 to T4 from TOF test1. Nondepolarizer2. Depolarizer{{c1::B}}
Published	07/30/2024	QC. FADE effect of T1 to T4 from TOF test1. Nondepolarizer2. Depolarizer{{c1::A}}
Published	07/30/2024	To appreciate FADE, you need to block {{c1::70-75}}% of the nicotinic receptors with nondepolarizing neuromuscular blocker
Published	07/30/2024	VR1. NMB given2. TOF ratio{{c1::B}}
Published	07/30/2024	% Receptors Blocked in fff. TOFC valuesTOFC 3: {{c1::75-80%}}TOFC 2: {{c1::80-85%}}TOFC 1: {{c1::85-90%}}TOFC 0: {{c1::>95%}}
Published	07/30/2024	Surgical Relaxation require TOFC value of?{{c1::0-3}}
Published	07/30/2024	T or FTOFC value of 4 indicates relaxation of muscles{{c1::False, need 0-3 value}}
Published	07/30/2024	Patient is in state of SURGICAL RELAXATION when:% receptors blocked: {{c1::75-95%}}TOF ratio: {{c1::0.2}}TOF count: {{c1::0-3}}
Published	07/30/2024	Patient is in state of RECOVERY when:TOF Ratio: {{c1::0.9-1.0}}TOF Count: {{c1::4}}
Published	07/30/2024	TOF ratio of <0.9 is considered full reversal of NMB {{c1::False, there's still residual blockage}}
Published	07/30/2024	First selective relaxant binding agent; Highly specific for reversal of steroid compounds{{c1::Sugammadex}}
Published	07/30/2024	VR1. Neostigmine2. ACh effect on NMJ {{c1::A}}
Published	07/30/2024	MOA of Sugammadex{{c1::Inactivate rocuronium - reversing NMB effect rapidly }}
Published	07/30/2024	QC. Performed first after surgery 1. Reversal of NMB 2. Allowing patient to come out of anesthesia {{c1::B}}
Published	07/30/2024	When should extubation performed after surgery?{{c1::Return of spontaneous respiration and pharyngeal reflex (e.g. swallowing)}}
Status	Last Update	Fields