34 Questions
What is the primary mechanism of action for non-depolarizing neuromuscular blockers?
Competitive antagonism of acetylcholine binding to nicotinic acetylcholine receptors
What is the typical effect of succinylcholine on train-of-four monitoring?
No fade and no post-tetanic facilitation
What is the primary mechanism by which an increase in immature forms of nicotinic acetylcholine receptors can lead to complications with neuromuscular blockers?
Increased sensitivity to succinylcholine leading to excessive potassium release
Which of the following is a key difference between succinylcholine and non-depolarizing neuromuscular blockers? (two answers)
Succinylcholine has a faster onset and shorter duration of action
What is the primary reason that routine use of succinylcholine in healthy children is now considered contraindicated?
Increased risk of hyperkalemia
What is the primary mechanism by which non-depolarizing neuromuscular blockers produce their effects?
Competitive antagonism of acetylcholine binding to nicotinic acetylcholine receptors
According to the 2023 ASA Practice Guidelines, what is the recommended neuromuscular monitoring site?
Adductor pollicis
What train-of-four ratio is recommended for extubation?
≥ 0.9
Which reversal agent is recommended for deep, moderate, or shallow neuromuscular blockade induced by rocuronium or vecuronium?
Sugammadex
What action is recommended for patients with adequate spontaneous recovery to a train-of-four ratio ≥ 0.9?
No pharmacological antagonism required
According to the guidelines, what is the primary objective of monitoring and antagonizing neuromuscular blockade?
To reduce the risk of residual neuromuscular blockade
What is the general rule regarding decreased potency of neuromuscular blockers?
Decreased potency results in more rapid onset of neuromuscular block
How do volatile anesthetics affect the potency of neuromuscular blockers?
Volatile anesthetics produce a dose-dependent potentiation of neuromuscular blockers
What is the primary issue with clinical assessment of recovery from neuromuscular blockade?
Clinical assessment is unreliable and predisposes the patient to a marked increase in morbidity
What is the issue with using a nerve stimulator without objective measurement?
Using a nerve stimulator without objective measurement results in a marked increase in the likelihood of residual paralysis
How do different muscles respond to neuromuscular blockade?
Muscles have markedly differing sensitivity to and recovery from neuromuscular block, which can lead to over- or under-estimation of onset and recovery
How do anticholinesterases work to reverse neuromuscular blockade?
Anticholinesterases increase levels of acetylcholine at the neuromuscular junction to compete with the neuromuscular blocker
What is the primary objective when monitoring the Train of Four ratio?
Achieving at least a 0.9 ratio for neuromuscular recovery assurance
Which muscle is most commonly stimulated during electromyography to measure the action potential?
Adductor pollicis
What does a deep neuromuscular block mean in clinical terms?
Return of diaphragmatic movement possible
Which placement is correct for the negative electrode during stimulation of the adductor pollicis muscle?
2 cm proximal to the wrist crease
When is reversal unnecessary after monitoring a Train of Four ratio?
>0.9 ratio and 4 twitches without fade
What muscle demonstrates delayed recovery relative to diaphragm and laryngeal muscles due to greater sensitivity in neuromuscular monitoring?
Adductor pollicis
What defines an intense neuromuscular block in monitoring criteria?
No response on post-tetanic count
Which muscle placement is appropriate for the stimulation of flexor hallucis brevis during neuromuscular monitoring?
Posterior to medial malleolus
Which of the following is a side effect of succinylcholine that is typically preventable with antimuscarinic pretreatment?
Bradydysrhythmias
What is the most common variant of atypical butyrylcholinesterase, and how does it affect the duration of succinylcholine block?
Homozygous atypical, with a dibucaine number of 20-30 and a block duration of 4-8 hours
Which of the following is a risk factor for the development of succinylcholine-induced myalgias?
Minor procedures
What is the primary mechanism by which succinylcholine can cause ventricular dysrhythmias?
Both increased catecholamines and decreased dysrhythmia threshold
Which of the following is a contraindication to the use of succinylcholine?
Both malignant hyperthermia and atypical/deficient pseudocholinesterase
What is the typical increase in serum potassium level following succinylcholine administration?
Approximately 0.5 mEq/L
Which of the following is an early warning sign of malignant hyperthermia associated with succinylcholine administration?
Masseter spasm with rigidity of other muscles
What is the recommended management for a patient who develops masseter spasm following succinylcholine administration?
Close observation of the patient for at least 12 hours, with monitoring of CK and urine myoglobin
Which of the following is a side effect of succinylcholine that is not typically associated with an increased risk of complications?
Increased intragastric pressure
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