Anesthesia: Muscle Relaxants

Front 1

Succinylcholine
1. Dose
2. Concentration

Back 1

1. 1-2 mg/kg (5 mg/kg IM)
2. 20 mg/mL

Front 2

Succinylcholine
1. Metabolism

Back 2

1. Pseudocholinesterase

*can have familial deficiency of this enzyme causing prolonged blockade. 30 mins if heterozygote and 8 hrs if homozygous.

*enzyme levels can be low in pregnancy, renal, lover dz, or drug use

Front 3

Succinylcholine
1. Dibucaine Number?
2. Normal?
3. Heterozygous?
4. Homozygous?

Back 3

1. Test pseudocholinesterase fxn by local anesthetic which inhibits the enzyme. If the enzyme isn't inhibited by dibucaine... it's likely abnromal
2. 80% Inhibition
3. 50%
4. 20%

Front 4

Succinylcholine
1. CV effects

Back 4

1. Succinylmonocholine metabolite stimulates SA note (should pretreat with atropine - esp with 2nd dose)

Front 5

Succinylcholine
1. AEs

Back 5

1. Fasciculations (pretreat with non-dep paralytic - weirdly, will need higher dose)
2. Muscle pains
3. High K (nl increase by 0.5 mEq/L. Must know baseline K.
4. Elevated intragastric and intraocular pressure
5. MH
6. Elevated ICP

Front 6

Succinylcholine
1. Which diseases to avoud Sux because of likely high K after given?

Back 6

1. Burns
2. Spinal cord injuries
3. Myopathies
4. Neurologic Disorders

*can give initially after burns and spinal cord injury... BUT CAN'T GIVE 24 HRS LATER!

Front 7

Non-depolarizing Muscle Relaxants
1. What 2 things might prolong NM block?

Back 7

1. Hypothermia
2. Low K, Low Ca, High Ca (or can lenghten block) and High Mg

Front 8

Non-depolarizing Muscle Relaxants
1. Onset of action (by muscle group)

Back 8

1. Diaphragm, laryngeal muscles, orbicularis oculi are MORE RESISANT AND RECOVER QUICKER (we use orbicularis as indicator of complete paralysis
2. Adductor pollicis recovers MORE SLOWLY (why we use it to show adequate recovery)

Front 9

Rocuronium
1. Dose
2. Concentration
3. Duration

Back 9

1. 1 mg/kg
2. 10 mg/mL
3. 1 hr (depending on dose)
4. Quick (1 min)

Front 10

Vecuronium
1. Dose
2. Concentration
3. Duration
4. Onset

Back 10

1. 0.1 mg/kg
2. 1 mg/mL
3. 1 hr
4. Slower (3 mins)

Front 11

Pancuronium
1. Dose
2. Concentration
3. Duration
4. Onset

Back 11

1. 0.1 mg/kg
2. 1 mg/mL
3. 2 hrs
4. Slower (3 mins)

Front 12

Cisatricurium
1. Dose
2. Concentration
3. Duration
4. Onset

Back 12

1. 0.1
2. 1 mg/mL
3. Very rapid
4. Medium (2 mins)

Front 13

Pancuronium
1. AEs

Back 13

1. Vagolysis, inc HR
2. Ventricular arrhythmias
3. Weakness

Front 14

Cicatracurium
1. Metabolism
2. Use in...
3. Toxic metabolite and clinical relevance

Back 14

1. Hofmann elimination (pH and temp dependent)
2. Laudanosine: CNS excitation, elevated MAC, and SEIZURES. No bronchospasm like atricurium.

Front 15

Atracurium
1. AE

Back 15

1. Bronchospasm

Front 16

Reversal Agents: Neostigmine
1. Dose
2. Concentration
3. Onset
4. Cross BBB?
5. Cross placenta?

Back 16

1. 50 mcg/kg (0.05 mg/kg)
2. 1 mg/mL
3. 10 mins
4. NO - QUARTERNARY AMMONIUM group prevents passage of BBB
5. YES

Front 17

Reversal Agents: Neostigmine
1. Give with what to prevent vagal effect?

Back 17

1. Glycopyrrolate or atropine

Front 18

Glycopyrrolate
1. Dose
2. Concentration
3. Onset
4. Cross BBB?
5. Cross placenta?

Back 18

1. 0.2 mg per 1 mg neostigmine
2. 0.2 mg/mL (so you give 1 ml for each mL neostigmine b/c neostigmine is 1 mg/mL)
3. Similar to neostigmine (10 mins)
4. NO - quarternary ammonium structure prevents
5. NO - have to use atropine to prevent fetal bradycardia

Front 19

What medication can you use to prevent secretions and salivation? What dose?

Back 19

1. Glycopyrrolate
2. 0.2 mg IV (total)

Front 20

Because neostigmine crosses the placenta, what drug might you use to prevent fetal bradycardia?

Back 20

1. Atropine (Glycopyrrolate does not cross the placenta)