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52 Cards in this Set
- Front
- Back
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Percentage of Ach receptors that must be blocked in order to block the AP
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95%
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Ratio of Ach molecules that actually make it to the receptors of the NMJ
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10:1
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Metabolizes succhs
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plasma cholinesterase
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Two definitions of NMB onset
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time it takes to produce 90% twitch depression
time it takes from administration until you get good intubating conditions |
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2 definitions of duration
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when is it going to wear off spontaneously
when is it reversible |
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Ultra short acting NMB
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succhs
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Short acting NMB
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Mivacurium
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Intermediate acting NMB
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Atracurium.
Cisatracurium. Rocuronium. Vecuronium |
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Long acting NMB
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Doxacurium.
Pancuronium |
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Nerve and muscle used to test readiness for muscle reversal
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ulnar nerve and adductor pollicis
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Muscle used to test readiness for intubation
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Corrugator Supercillii
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Where does Ach bind
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2 alpha subunits
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% of receptors that must be blocked on the MEP in order to interfere with an AP
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75%
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What kind of structure is Sch
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charged quaternary
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Depolarizing NMB
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Sch
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How do non-depolarizing NMB work
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prevent AchGC from opening
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2 definitions of onset
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90% twitch reduction
how long it take until intubating conditions |
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When can we reverse
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2/4 in TOF
5 seconds sustained tetany |
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Where is the ulnar nerve in r/t the hand
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pinky side
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How do you place the electrodes of your nerve stimulator
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black- over nerve
red- anywhere that ISN'T over the muscle |
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Muscle that goes away last and comes back first
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diaphram
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Muscle used to test readiness to intubate
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corrugator supercilli
orbicularis oculi |
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Nerve used to test readiness to reverse
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ulnar-adductor pollicis
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Best stimulus method for intubation
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single twitch
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4th twitch disappears
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70% blocked
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3rd twitch disappears
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80% blocked
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2nd twitch disappears
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90% blocked
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Number of contractions on TOF that is indicated for abd surgery relaxation
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1-2
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Best stimulus method for extubation and maintenance during a case
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TOF
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What change in temperature can change the TOF response
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decrease in temp
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What is fade and what does it tell you
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TOF- 4th < 1st
residual blockade |
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What are two advantages of double burst
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able to detect residual blockade better that TOF
Can detect a response in deep blocks |
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What is the minimum interval of time that you can repeat double burst
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12 seconds
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What does sustained tetany for < 5 seconds tell us
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not ready for reversal
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What are 3 advantages to tetanus stimulation
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can determine type of block
sensitive indicator of residual block detects deep blocks |
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What is the minimum interval of time that you can repeat tetanus
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1 minute
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When evaluating the TOF response, what does depression with fade tell you about the type of NMB administered
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non-depolarizing NMB
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Which muscles paralyze first
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small rapid moving
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How do you know when to intubate when paralyzing with sch
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when fasiculations are gone
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What is fade
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gradual failure of a muscle contraction during stimulation
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What is ED50 and ED95 as it deals with NMB
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50 and 95 % depression of twitch height
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What is the recovery index
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the time between giving a drug and 25-75% recovery of twitch
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How will you go about measuring muscle relaxation during surgery
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1-2 twitches on TOF
q 15 minutes pads on wrist |
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Duration of Sch
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5-10 minutes
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Additive with Ach
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Sch
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What kind of receptors does Sch depolarize
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pre, post, and extrajunctional
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What is phase 2 and what causes it
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when Sch causes nondepolarizing blockade
Sch gtt; inadequate metabolism |
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What causes a desensitization block
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decreased Ach receptors
occurs when something is destroying receptors or abnormally activating them ie conformational change, down regulation |
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How will a patient who is desensitized respond to NMB
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resist depolarizers
very susceptible to nondepolorizers |
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What factors are most likely to cause a desensitized block
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people with nicotine patches
poor metabolism overdose of Sch |
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How do you prevent fasiculations and the increased CO2 and ICP that come along with it
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give a defasiculating dose of a nondepolarizer with a strong affinity for presynaptic receptor
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What drugs are used for defasiculating dose
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Roc 0.04
Atac 0.02 |
