Neuromuscular Blockers and Reversal
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Questions and Answers

What is the primary mechanism of action for non-depolarizing neuromuscular blockers?

  • Interference with calcium release from the sarcoplasmic reticulum
  • Activation of nicotinic acetylcholine receptors leading to depolarization
  • Inhibition of acetylcholinesterase
  • Competitive antagonism of acetylcholine binding to nicotinic acetylcholine receptors (correct)

    • What is the typical effect of succinylcholine on train-of-four monitoring?

  • No fade and no post-tetanic facilitation (correct)
  • Fade in the train-of-four response
  • Post-tetanic facilitation
  • Increased train-of-four ratio

    • What is the primary mechanism by which an increase in immature forms of nicotinic acetylcholine receptors can lead to complications with neuromuscular blockers?

  • Decreased sensitivity to both depolarizing and non-depolarizing neuromuscular blockers
  • Altered metabolism of neuromuscular blockers
  • Increased sensitivity to succinylcholine leading to excessive potassium release (correct)
  • Increased sensitivity to non-depolarizing neuromuscular blockers

    • Which of the following is a key difference between succinylcholine and non-depolarizing neuromuscular blockers? (two answers)

    <p>Succinylcholine has a faster onset and shorter duration of action (D)</p> Signup and view all the answers

    What is the primary reason that routine use of succinylcholine in healthy children is now considered contraindicated?

    <p>Increased risk of hyperkalemia (C)</p> Signup and view all the answers

    What is the primary mechanism by which non-depolarizing neuromuscular blockers produce their effects?

    <p>Competitive antagonism of acetylcholine binding to nicotinic acetylcholine receptors (D)</p> Signup and view all the answers

    According to the 2023 ASA Practice Guidelines, what is the recommended neuromuscular monitoring site?

    <p>Adductor pollicis (B)</p> Signup and view all the answers

    What train-of-four ratio is recommended for extubation?

    <p>≥ 0.9 (C)</p> Signup and view all the answers

    Which reversal agent is recommended for deep, moderate, or shallow neuromuscular blockade induced by rocuronium or vecuronium?

    <p>Sugammadex (A)</p> Signup and view all the answers

    What action is recommended for patients with adequate spontaneous recovery to a train-of-four ratio ≥ 0.9?

    <p>No pharmacological antagonism required (B)</p> Signup and view all the answers

    According to the guidelines, what is the primary objective of monitoring and antagonizing neuromuscular blockade?

    <p>To reduce the risk of residual neuromuscular blockade (C)</p> Signup and view all the answers

    What is the general rule regarding decreased potency of neuromuscular blockers?

    <p>Decreased potency results in more rapid onset of neuromuscular block (D)</p> Signup and view all the answers

    How do volatile anesthetics affect the potency of neuromuscular blockers?

    <p>Volatile anesthetics produce a dose-dependent potentiation of neuromuscular blockers (C)</p> Signup and view all the answers

    What is the primary issue with clinical assessment of recovery from neuromuscular blockade?

    <p>Clinical assessment is unreliable and predisposes the patient to a marked increase in morbidity (A)</p> Signup and view all the answers

    What is the issue with using a nerve stimulator without objective measurement?

    <p>Using a nerve stimulator without objective measurement results in a marked increase in the likelihood of residual paralysis (A)</p> Signup and view all the answers

    How do different muscles respond to neuromuscular blockade?

    <p>Muscles have markedly differing sensitivity to and recovery from neuromuscular block, which can lead to over- or under-estimation of onset and recovery (D)</p> Signup and view all the answers

    How do anticholinesterases work to reverse neuromuscular blockade?

    <p>Anticholinesterases increase levels of acetylcholine at the neuromuscular junction to compete with the neuromuscular blocker (B)</p> Signup and view all the answers

    What is the primary objective when monitoring the Train of Four ratio?

    <p>Achieving at least a 0.9 ratio for neuromuscular recovery assurance (A)</p> Signup and view all the answers

    Which muscle is most commonly stimulated during electromyography to measure the action potential?

    <p>Adductor pollicis (B)</p> Signup and view all the answers

    What does a deep neuromuscular block mean in clinical terms?

    <p>Return of diaphragmatic movement possible (C)</p> Signup and view all the answers

    Which placement is correct for the negative electrode during stimulation of the adductor pollicis muscle?

    <p>2 cm proximal to the wrist crease (D)</p> Signup and view all the answers

    When is reversal unnecessary after monitoring a Train of Four ratio?

    <p>&gt;0.9 ratio and 4 twitches without fade (A)</p> Signup and view all the answers

    What muscle demonstrates delayed recovery relative to diaphragm and laryngeal muscles due to greater sensitivity in neuromuscular monitoring?

    <p>Adductor pollicis (B)</p> Signup and view all the answers

    What defines an intense neuromuscular block in monitoring criteria?

    <p>No response on post-tetanic count (B)</p> Signup and view all the answers

    Which muscle placement is appropriate for the stimulation of flexor hallucis brevis during neuromuscular monitoring?

    <p>Posterior to medial malleolus (D)</p> Signup and view all the answers

    Which of the following is a side effect of succinylcholine that is typically preventable with antimuscarinic pretreatment?

    <p>Bradydysrhythmias (C)</p> Signup and view all the answers

    What is the most common variant of atypical butyrylcholinesterase, and how does it affect the duration of succinylcholine block?

    <p>Homozygous atypical, with a dibucaine number of 20-30 and a block duration of 4-8 hours (D)</p> Signup and view all the answers

    Which of the following is a risk factor for the development of succinylcholine-induced myalgias?

    <p>Minor procedures (C)</p> Signup and view all the answers

    What is the primary mechanism by which succinylcholine can cause ventricular dysrhythmias?

    <p>Both increased catecholamines and decreased dysrhythmia threshold (A)</p> Signup and view all the answers

    Which of the following is a contraindication to the use of succinylcholine?

    <p>Both malignant hyperthermia and atypical/deficient pseudocholinesterase (D)</p> Signup and view all the answers

    What is the typical increase in serum potassium level following succinylcholine administration?

    <p>Approximately 0.5 mEq/L (A)</p> Signup and view all the answers

    Which of the following is an early warning sign of malignant hyperthermia associated with succinylcholine administration?

    <p>Masseter spasm with rigidity of other muscles (D)</p> Signup and view all the answers

    What is the recommended management for a patient who develops masseter spasm following succinylcholine administration?

    <p>Close observation of the patient for at least 12 hours, with monitoring of CK and urine myoglobin (C)</p> Signup and view all the answers

    Which of the following is a side effect of succinylcholine that is not typically associated with an increased risk of complications?

    <p>Increased intragastric pressure (B)</p> Signup and view all the answers

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