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Title:

Monitoring Neuromuscular Blockade

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Also increases blood flow to area. Tetanic Stimulation ... 2nd lead proximal to 1st or in olecranon groove. look only at the thumb. Site of Stimulation ... – PowerPoint PPT presentation

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Title: Monitoring Neuromuscular Blockade


1
Monitoring Neuromuscular Blockade
2
Peripheral Nerve Stimulation
  • All patients receiving neuromuscular relaxants
    should have neuromuscular function monitored
    during surgery.

3
Patterns of Stimulation
4
Characteristics of Stimulus
  • Monophasic (square) impulse
  • Duration lt 0.5 MSEC

5
Single Twitch (0.1 Hz - 1.0 Hz)
  • Least precise
  • Need baseline
  • First indication 75-80 block
  • Twitch disappears 90-95 block
  • Also increases blood flow to area

6
Tetanic Stimulation
  • Repetitive high-frequency (30-100 Hz)
    stimulation
  • Persistent muscle contraction
  • Fade when NDMRs are used
  • inhalation agents augment fade
  • Posttetanic facilitation

7
Train of Four Stimulation
  • 4 impulses at 2Hz
  • Most common use of stimulator
  • Does not require baseline
  • compares 4th twitch to 1st twitch
  • T4/T1 ratio indicates fade

8
Train of 4 Stimulation (Contd)
  • Loss of twitches
  • T4 70 - 75 block
  • T3 85 block
  • T2 85 - 90 block
  • T1 90 - 95 block

9
What are the Characteristics of
  • Depolarizing block
  • normal
  • overdose
  • Nondepolarizing block
  • normal
  • overdose

10
Posttetanic Count
  • Used when no twitches are present
  • Technique
  • 5 sec. 50 Hz tetanus
  • pause 3 sec
  • stimulate at 1 Hz
  • count twitches

11
Postetanic Count
  • Number of twitches present is inversely related
    to the time of return of train of four

12
Sites of Stimulation
  • Adductor pollicis
  • most common site
  • 1 lead over ulnar nerve proximal to the wrist
  • 2nd lead proximal to 1st or in olecranon groove
  • look only at the thumb

13
Site of Stimulation
  • Orbicularis oculi
  • stimulate facial nerve
  • electrodes near tragus
  • may directly stimulate muscle
  • not quantifiable

14
Hints for Relaxant Use
  • Check batteries prior to case
  • use only recommended batteries
  • Properly position electrodes
  • Cords are usually ready for intubation before Tof
    is flat

15
Hints for Relaxant Use (Contd)
  • Document return of twitch following sux before
    giving a NDMR
  • After patient is intubated, reduce loading dose
    of NDMR

16
Hints for Relaxant Use (Contd)
  • Titrate relaxant to twitch
  • Do not reverse until at least 1 twitch has
    returned
  • Document sustained tetanus after reversal
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