What are the phases of monitoring?
- Baseline
- Check functioning of neuromuscular monitor
- choose the appropriate nerve/muscle to be monitored
- Intubation
- Maintenance
- redosing
- observation and interpretation of evoked response
- Emergence
- reversal
- observation and interpretation of evoked response
When should you check your baseline?
Before the neuromuscular blocker is administered but after induction of anesthesia
How do you place the electrodes?
Order the muscles from most resistant to non depolarizing muscle relaxants to most sensitive
- Most resistant
- vocal cord
- diaphragm
- orbicularis oculi
- abdominal rectus
- adductor pollicis
- masseter
- pharyneal
- extraocular
- Most sensitive
Chart of TOF responses
How do you calculate the TOF ratio?
What is the difference between the TOF ratio for a Non-depolarizing block and the TOF ratio for a depolarizing block?
- B/A = TOF ratio (on this pic it is the 4th line/1st line=TOF)
- Depolarizing block has no fade so the TOF ratio is 1
What percent of block remains with 3 responses abolished?
What percent of block remains with 2 responses abolished?
1?
All responses equal?
Onset time definition
time from injection to peak effect
Types of NMB doses that can be given
- intubating dose- max dose
- relaxant dose- lower dose for maintenance
- 20% of intubating dose
- defasiculating dose-
- 10% of intubating dose
what is the goal of maintaining a block?
What twitch suppression do you need for abdominal surgery?
- Maintain the minimum depth of block that is required for the surgery
- 80% twitch depression
- correlates with 1 or 2 twitches present from train of 4
What is the preffered site for monitoring recovery from block?
adductor pollicis
When do you use the post tetanic count?
Used in profound block when there is no response to TOF
What is tetanic stimulation?
Rapid 50-200 Hz delivery of stimulus given for every 5 seconds
When would you see a sustained response to a Tetanic stimulation?
normal neuromuscular transmission and depolarizing block
When would a Tetanic stimulation not be sustained?
during a non-depolarizing and phase 2 depolarizing block