reversal of NDMR

Discussion in 'Anesthesiology' started by refreshingred, Jul 26, 2006.

  1. refreshingred

    refreshingred Member
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    Why is it that I have read that you must have at least one twitch before attempting to reverse? Could someone please explain the physiology?
     
  2. DreamMachine

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  3. SusyQ

    SusyQ New Member
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    I have not read anything related to how 'high' you are supposed to turn your twitch monitor on. I think the only important relationships are TOF *ratios.* And as far as the boards I'm fairly certain that the literature deems an acceptable reversal as a TOF ratio of >0.7.
     
  4. DreamMachine

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  5. Noyac

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    I have to admit that I am not to versed (not midazolam) on this subject but I remember a fellow (not fellowship) resident that used too much reversal and had some NM blockade after getting to the PACU. I never really understood it but he did some research on the subject. Personally, I think he just tried to reverse the pt without any twitches and the pt reparalyzed in the PACU. The idea if I remember right is that the nondepolarizer actually has a longer 1/2 life than the reversal agent and therefore it must be metabolized enough b/4 reversal.
     
  6. VentdependenT

    VentdependenT You didnt build thaT
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    if you give the reversal when the receptors are flooded with NDMR then you are screwed (relatively) for a while. why? because if you give em more neostigmine before the previous 5mg wear off you could send the pt into a cholinergic crisis which in itself causes MUSCLE WEAKNESS. Then you have absolutely no friggen idea what the hell is goen on.

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  7. Cap'nOblivious

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    My understanding of this concept is, basically, use the current that you established a baseline with. Don't check twitches after pushing propofol with 40mA, then later in the case use 80 just to see the fade more accurately. This will give you a false impression of strength of muscle-response. Am I wrong about this, anyone?
     
  8. DreamMachine

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