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What is the only NBM to cause bradycardia in children and why?
bc it mimics Acet and directly stimulates muscarinic receptors at the SA node
List 5 conditions in which administering Anectine to the patient would raise concern for the CRNA...
Up regulation of cholinergic nicotinic receptors leading to increased release of potassium....
- 1. thermal trauma (burns)
- 2. spinal cord transection; paraplegia or hemiplegia
- 3. skeletal muscle trauma
- 4. upper motor neuron injury (head injury, CVA, Parkinsons's disease)
- 5. Prolonged immobility
What are the symptoms noted that would lead to the diagnosis of MH?
- Increased CO2
- Fever (pyrexia)
- Increased HR
- Failure of masseter muscle to relax
Where is the defect of MH??
It is a mutation of the ryanodine receptor.
Where is the ryanodine receptor located? And What happens if you have a mutation of this receptor??
It is positioned in the sarcoplasmic reticulum of skeletal muscle. The SR releases calcium continuously with MH, leading to sustained contractions and increased metabolism.
What is the treatment for MH? What how does the drug work?
Acts on SR to decrease Ca
What is the earliest, most sensitive and specific sign of MH?
What are the initials signs of MH?
tachycardia and tachypnea
due to the SNS stimulation bc of increased metabolism and hypercarbia
Which drugs can trigger MH?
Sch and halogenated inhalational agents
Why is heart muscle not directly affected by MH?
Because in the heart muscle, the RyR2 isoform is present.. NOT RyR1
How do corticosteroids affect the administration of NMB?
they do not affect your blockade
How do anticonvulsants affect the block created by NMB?
the decrease the block if patients are treated chronically with anticonvulsants
How does acute administration of phenytoin affect NMB?
It increases your block
How does myasthenia gravis affect your block when anectine is given?? what about your nondepolarizers??
- Anectine -- block is decreased
- Nondepolarizers -- block is increased
4 stimuli every 0.5 seconds = 2 Hz
Define tetanic stimulation
50 Hz, 5 s
Define Double Burst Stimulation
two short bursts of 50 Hz tetanic stimulation separated by 750ms