Twitch monitoring (13) Flashcards Preview

Anesthesia Pharm 1-Josh > Twitch monitoring (13) > Flashcards

Flashcards in Twitch monitoring (13) Deck (34)
Loading flashcards...
1
Q

depolarizes such as sux’s is 2 molecules acting like ACh at the post synaptic receptor and is characterized by two phases! what occure in phase 1

A
  • decreased single twith
  • No fade (decrease but sustained response) to continuous stimuli
  • TOF ratio greater than 0.7
  • potentiation by anti-cholinesterase drugs
  • causes fasculations
2
Q

depolarizes such as sux’s is 2 molecules acting like ACh at the post synaptic receptor and is characterized by two phases! what occure in phase 2

A

resembles non-depolarizers characteristics

  • decreased twitch to a single stimulus
  • produce FADE (unsustained response) to continual stimulus
  • TOF ratio < 0.7
  • post tetanic facilitations
3
Q

Non-depolarizeres act on at least 1 alpha subunit to block conduction what are their characteristics

A
  • decreased twitch to a single stimulus
  • produce FADE (unsustained response) to continual stimulus
  • TOF ratio < 0.7
  • post tetanic facilitations
  • potentiation by other non-depolarizers
  • antagonism by anticholinesterase drugs
4
Q

why do we relax muscles

A
  • for optimal intubation conditions
  • facilitate surgical exposure/manipulation
  • improve mechanical ventilation
  • to compensate for inadequate or light anesthesia
5
Q

what is teh purpose of nerve monitoring

A

to evaluate the degree of muscle paralysis or recovery from paralysis

6
Q

Hz for a single twitch

A

0.1-0.15 Hz one time

7
Q

how does TOF work with nerve monitoring

A

2Hz 0.5 sec apart

8
Q
what do the twitches look like
if you could see them in the form a a line (real practical)
single
TOF
TOF with fade
A

single
_________

TOF
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
TOF with fade
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_
\_\_\_\_\_\_
\_\_\_\_

(i know looks just like real life real easy to invision)

9
Q

Non-depolarizers fade 2 characteristics

A

–exhibit FADE on TOF
–the fade may progress to no twitches if enough NDMR is given
ex::
| I __________ FIRST DOSE
| N ________
| C ______
| R ____
| E
| A
| S ________ CONT’D DOSING
| I ______
| N ____
| G __
|
| N
| D ____ ANOTHER DOSE
| M __
| R
|
| D
| O __ WHAT THE HELL MORE
| S
| E
| NONE AHHH GONE
V

10
Q
************************************must know
How do you know the degree of block with TOF
use 
R1
R2
R3
R4
R=response to nerve monioring with TOF
questions see slide 45
A
R4--decreaes at 75% receptors blocked
R3--decreaes at 85% receptors blocked
R2--decreaes at 90% receptors blocked
R1--decreaes at 95% receptors blocked
ex::: with TOF
R1 \_\_\_\_\_\_\_\_\_\_
R2 \_\_\_\_\_\_\_\_\_\_
R3 \_\_\_\_\_\_\_\_
R4 \_\_\_\_\_\_

so this shows the first decrease was at R3 so that indicates this individual hypothetical made up patient is 85% blocked!!!!
so just remember if you are checking to see is someone is blocked and you do TOF and only the very last twitch is slightly faded your still at least 75% block thats still alot!!!

11
Q

clinical application to nerve monitoring %

  • surgical relaxation is appretiated at
  • intubation facilitated at what
  • total flaccidity
A
  • surgical relaxation is appretiated at >90%
  • intubation facilitated at 95%
  • total flaccidity at 99%
12
Q
Examples of TOF with depolarizing blockade (SUXs) TOF
baseline TOF
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
A
baseline TOF
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
Phase 1 
\_\_\_\_\_
\_\_\_\_\_
\_\_\_\_\_
\_\_\_\_\_

(notice no fade, but all are at about half strength of baseline) (called 4/4 TOF with less amplitude)

Phase 2

(no I didn’t forget any lines thats it, when depolarizers go into phase 2 usually there are no twitches)
recorded as 0/4

13
Q

quick reveiw

  • do NDMR have fade?
  • Depolarizes have 2 phases describe their TOF
A
  • do NDMR have fade?
  • -yes
  • Depolarizes have 2 phases describe their TOF
  • phase 1-seen as TOF 4/4 with less amplitude
  • phase 2 seen as TOF 0/4 NO TWITCHES

way to go if your correct pat yourself on the back!! if your wrong kick yourself in the nuts for not paying attention and do it again dumbass

14
Q

3 most frequently used musles for nerve monitoring

A

no specific order

1) ulnar-adductor pollicis
2) facial- Currigator Supercilii
3) posterior tibial- flexor hallucis

15
Q

this was not in our notes but from all of the pictures and a CRNA I asked what lead goes where for nerve monitoring (Red and Black)

A

black -distal
red closest to heart.
just an fYI dont memorize

16
Q

where are the leads for the adductor pollicis (hmm where is that muscle) and what should you see to show proper twitch eval

A

ulnar (palmar) side of distal forearm.
the thumb should show adduction
hmm lets find a hint:
ok so we are testing the ADDUCTOR pollicis and the proper eval is ADDUCTION of the thumb!!!!!!! skadush (sir wizard Atkins, J., 2012) ( I have to give credit to the Skaduch)

17
Q

what would be seen in the adductor pollicis twitch if the placement of the leads are wrong for example on the median nerve or direct muscle

A

finger contraction

18
Q

what is the facial nerve we access for with twitch

A

Curragator Supercillii
(in his notes he places emphisis on NOT THE ORBICULARIS OCULI)
HOW TO REMEMBER- this is a streatch so if you have a better one place let me know- Curragator= Cornea
superCILLII= Cilli (hairy projections) your eyebrow????

19
Q

Facial nerves efferent or afferent

A

primarily efferent (motor control)

20
Q

the facial nerve is cranial nere number???

A

XII

21
Q

**5 branches of the cranial nerve

A
temporal
zygomatic
maxillary
mandibular
buccal
22
Q

where is placement of nerve leads for posterial tibial nerve (flexor Hallucis) monitoring

A

behind the medial malleolus

23
Q

stimulation of the posterior tibial nerve (flexor hallucis) causes what response

A

flexion of the big toe by contraction of the flexor hallucis

24
Q

what is teh nerve we monitor in the posterior tibia

A

flexor hallucis

25
Q

which nerve is best to monitor??? and why

A

the corrugator supercilli (face) is relatively resistant to blockade and very similar to diaphragm resistance
so monitor the facial nerve for intubation and abd rectus paralysis
-the ulnar (adductus pollicis) is very easliy blocked so monitor for extubation adequacy
hint:
go to sleep and stay asleep with eyes closed, and wake up with thumbs up!!!

26
Q

again to ensure you grasped it’s importance when do you monitor the face and ulnar nerve

A

go to sleep and stay asleep with eyes closed, and wake up with thumbs up!!!

27
Q

name the % of receptors occupied (you need to know this)
Normal TV
Holds tetanus 50Hz
Equal TOF, DBS
Holds tetnas 100Hz
Head lift x 5 secs

A

Normal TV–0-80% may be blocked
Holds tetanus 50Hz–0-75%or80% may be blocked
Equal TOF, DBS–0-75% or 80% may be blocked
Holds tetnas 100Hz–0-50% may be blocked
Head lift x 5 secs–0-33% may be blocked

just remember these are UP TO amounts a very wide range.

28
Q

What is single twicth monitoring for

A

allows continual eval of DEPOLARIZING block

29
Q

what is TOF for

A

allows est of DEGREE on NON-DEPOLARIZERS

30
Q

what is DBS for

A

easier visual eval of fade, give same info as TOF

31
Q

what is tetanic stimulation for

A

more detailed assessment of degree of NON-DEPOLARIZERS block

32
Q

what is post tetanic stimulation count (PTC) for

A

allows quantifaction of block if no TOF

est what cholinesterase inhibitor reversal drugs may acheive for you

33
Q

does giving tetany affect suxs

A

no!!

34
Q

do you monitor NDMbD the same as DMBD

A

no

suxs has no post tetanic and no fade