Slide 1
ASATT 2016
Neuro Muscular Blocking Agents and Nerve Stimulation Presented
by Kevin Lueders, Bell Medical, USA Corlius Birkill, Xavant
Technology, S. Africa
#DisclosuresKevin Lueders, President and Owner of Bell Medical
since 1986. Bell Medical has specialized in anesthesia products
since 1975. We are the master distributor in the USA and Canada for
the Stimpod NMS 450 from Xavant Technologies, South AfricaCorlius
Birkill, President of Xavant TechnologiesOur websites are:
www.BellMedical.com and www.Xavant.com
#Anesthesia in the good old days
#OverviewHistory of neuromuscular blocking agents (NMBA) Nerve
Stimulation modesResidual Neuromuscular Block (RNB) (PORC)
(CRE)Reversal drugsSubjective verses Objective (Quantitative) TOF
MonitoringBasic and advanced TOF monitoring methodsMonitoring
location optionsStandards:APSF Endorsement of Quantitative TOF
MonitoringAANA and ASA Standards in Anesthetic Monitoring
#In this learning module we will begin with a brief overview of
some common capnography terms, a basic understanding of capnography
and the normal physiology of the respiratory cycle. We will then
discuss the new 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
that recommend waveform capnography for confirmation of ET tube
placement, monitoring CPR quality, and return of spontaneous
circulation (ROSC).
The Paralytics
#The ParalyticsCurare, the worlds first paralytic Used by S.
American Indians for centuries for hunting First recorded in 1500s
by explorersFirst used in anesthesia in 1942Suxamethonium or Sux
first used in 1949Pancuronium, 1960s, Vecuronium 1970s, Rocuronium
late 1980s and 1990s.
#The Reversal Drugs NeostigmineRecommended TOFc 2/4 before
administeredNeostigmine has a ceiling effect (doses >0.05 mg/kg
have no greater efficacy)Neostigmine cannot reverse deep
NMBNeostigmine in the absence of NMB causes pharyngeal and
esophageal muscle relaxationSugammadex (recently FDA approved in
USA)
#NMBA Affect on Anesthesia PracticeNMBAs revolutionized the
practice of anesthesiaBefore NMBAs anesthesia was induced with
inhalation agents to a point of respiratory and cardiac depression.
Tracheal intubation was uncommon. After NMBA anesthesia became a
triad of narcosis, analgesia and muscle relaxation.Tracheal
intubation became common practice
#NMBA Safety IssuesResidual Neuromuscular Block (RNB) (PORC)RNB
defined TOF ratio
