neuromuscularBlockUpdateMay06

neuromuscularBlockUpdateMay06 - Update on Neuromuscular...

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Unformatted text preview: Update on Neuromuscular Relaxants Charles E. Smith, MD Professor of Anesthesia Case Western Reserve University Director, Cardiothoracic Anesthesia MetroHealth Medical Center Cleveland, Ohio Objectives Mechanism of action Monitoring Pharmacology non-depolarizers depolarizers Reversal Historical 1942: dTC, long-acting, histamine 1952: sux 1954: 6 fold in mortality with dTC 1967: panc, long acting, CV stimulation 1986: interm acting relaxants: vec: no CV effects atrac: Hoffman elimination, histamine 1990 to present: newer agents to fill specific niche roc, cis, miv, pip, dox; rap: withdrawn from market Drachman, NEJM Classical Mechanism of Action Non-depolarizers : competitive block prevent binding of Ach to receptor Depolarizers- mimic action of Ach excitation followed by block Taylor: Anesthesiology 1985;63:1-3 Postjunctional Nicotinic AchR Standaert FG: 1984 Margin of Safety Wide margin of safety of neuromuscular transmission 70% receptor occupancy before twitch depression Receptor alterations burns, MG, quadra- +hemiplegia Viby-Mogensen, 1984 TOF Monitoring TOF: 4 supramaximal stimuli at 2 Hz, every 0.5 sec observe ratio of 4rth twitch to first Loss of all 4 twitches: profound block Return of 1-2 twitches: sufficient for most surgeries Return of all 4 twitches: easily reversible A-Nondepolarizing. B- Sux. Viby-Mogensen: BJA 1982;54:209 Onset + Recovery of NM Block Terminology Efficacy : ability of drug to produce a desired effect Potency : quantity of drug to produce maximum effect Biologic variability : individual variation in response to identical dose of drug DRC : measure efficacy and potency compare drugs, disease states Concept of Effective Dose ED 90 : dose that produces 90% block (+ SD) in average patient at standard muscle group Usually adductor pollicis- ulnar nerve Derived from dose-response studies Intubating dose: 2- 3 x ED 90 Repeat doses: < ED 90 DRC- show differences in potency, slope, efficacy + individual respo Donati F: Semin Anesth 2002;21:120; Donati F: Anesthesiology 198...
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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neuromuscularBlockUpdateMay06 - Update on Neuromuscular...

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