NAGELHOUT CH 40 TEST PAPER
QUESTIONS AND SOLUTIONS EXPERT
VERIFIED STUDY CONTENT
●● Short Acting Nondepolarizing NMBs
(Length of duration)
Answer: Mivacurium
(20-30 minutes)
●● Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration)
Answer: Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
●● Long Acting Nondepolarizing NMB
(Length of duration)
Answer: Pancuronium
(60-90 minutes)
,●● NMB Reversal Agents (3)
Answer: Neostigmine
Edrophonium
Sugammadex
●● NMBs work at ____ receptors
Answer: Nicotinic Cholinergic (sub-m)
●● Nicotinic Cholinergic (sub-m) use positive or negative feedback?
Answer: Positive feedback. This explains fade with NDMBs.
●● Neurotransmitter of the NM junction
Answer: acetylcholine
●● Breaks down acetylcholine at the NM synapse/junction
Answer: acetylcholinesterase
●● Phase 2, Non-depolarizing agents are: agonists or antagonists
Answer: Antagonist
●● Phase 1, Depolarizing agents act as: agonist or antagonist??
,Answer: Agonist then antagonist
●● Train of Four Ratio
Answer: Strength of 4th twitch:Strength of 1st twitch (when it is 90%
patient considered recovered)
●● Best nerve/muscle to measure onset of NMB
Answer: Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
(negative-black electrode over nerve)
●● Best nerve/muscle to measure emergence from NMB
Answer: Ulnar Nerve
Adductor Pollicis
Measures thumb adduction (Red proximal)
●● Single Twitch Test
Answer: 1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
, ●● Train of Four Test
Answer: 4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
*Succ has no fade, all 4 twitches equal*
●● Double Burst Simulation (DBS) Test
Answer: 2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
●● Tetanus Test
Answer: 100 Hz twitch for 5 seconds
Painful
●● Posttetanic Count Test
Answer: 50 Hz stimulus for 5 sec → 3 sec pause → 1 Hz single twitch
every second
Only used when patient is 100% paralyzed
0 = call for ventilator (>9 minutes til TOF)
4 = 4 minutes until TOF possible
8= 0-2 minutes until TOF
QUESTIONS AND SOLUTIONS EXPERT
VERIFIED STUDY CONTENT
●● Short Acting Nondepolarizing NMBs
(Length of duration)
Answer: Mivacurium
(20-30 minutes)
●● Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration)
Answer: Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
●● Long Acting Nondepolarizing NMB
(Length of duration)
Answer: Pancuronium
(60-90 minutes)
,●● NMB Reversal Agents (3)
Answer: Neostigmine
Edrophonium
Sugammadex
●● NMBs work at ____ receptors
Answer: Nicotinic Cholinergic (sub-m)
●● Nicotinic Cholinergic (sub-m) use positive or negative feedback?
Answer: Positive feedback. This explains fade with NDMBs.
●● Neurotransmitter of the NM junction
Answer: acetylcholine
●● Breaks down acetylcholine at the NM synapse/junction
Answer: acetylcholinesterase
●● Phase 2, Non-depolarizing agents are: agonists or antagonists
Answer: Antagonist
●● Phase 1, Depolarizing agents act as: agonist or antagonist??
,Answer: Agonist then antagonist
●● Train of Four Ratio
Answer: Strength of 4th twitch:Strength of 1st twitch (when it is 90%
patient considered recovered)
●● Best nerve/muscle to measure onset of NMB
Answer: Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
(negative-black electrode over nerve)
●● Best nerve/muscle to measure emergence from NMB
Answer: Ulnar Nerve
Adductor Pollicis
Measures thumb adduction (Red proximal)
●● Single Twitch Test
Answer: 1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
, ●● Train of Four Test
Answer: 4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
*Succ has no fade, all 4 twitches equal*
●● Double Burst Simulation (DBS) Test
Answer: 2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
●● Tetanus Test
Answer: 100 Hz twitch for 5 seconds
Painful
●● Posttetanic Count Test
Answer: 50 Hz stimulus for 5 sec → 3 sec pause → 1 Hz single twitch
every second
Only used when patient is 100% paralyzed
0 = call for ventilator (>9 minutes til TOF)
4 = 4 minutes until TOF possible
8= 0-2 minutes until TOF
