Basics
What are NMBAs?
These medications produce skeletal muscle paralysis
Nicknamed “Suck”
What is Succinylcholine?
A patient receives Rocuronium. Can they breathe on their own?
No.
What does TOF monitor?
Depth of paralysis
Which medications should always accompany NMBAs?
Sedatives and analgesics
NMBAs provide neither ____ nor ____.
What are sedation and analgesia?
Nicknamed “Rock”
What is Rocuronium?
Which ventilator mode should usually be used after giving a paralytic?
Assist-control (controlled ventilation)
What is the desired TOF goal?
1-2 twitches out of 4
A patient is awake, hears everything, feels pain, but cannot move because of an NMBA. This is known as:
Locked-in-state
Where do NMBAs work?
At the neuromuscular junction
This nondepolarizing drug is commonly used as a continuous paralysis infusion
What is Cisatracurium (Nimbex)?
Can a patient cough while paralyzed?
A TOF shows 4/4 twitches
There is essentially no neuromuscular blockade.
Which NMBA can be reversed with Sugammadex (Bridion)?
Rocuronium (and Vecuronium)
NMBAs block which neurotransmitter from activating skeletal muscle?
What is acetylcholine (ACh)?
This drug is considered the gold standard for RSI because of its rapid onset and short duration
What is Succinylcholine?
A patient on a paralytic suddenly desaturates. Since they cannot cough, what RT intervention is most likely needed?
Airway suctioning
A TOF shows 0/4 twitches
The patient is excessively paralyzed
Which type of NMBA causes fasciculations before paralysis?
Depolarizing NMBA (Succinylcholine)
True or False:
NMBAs cross the blood-brain barrier.
False
Name the three major side effects of Succinylcholine
Hyperkalemia, malignant hyperthermia, bradycardia/arrhythmias
Why should a patient NEVER be extubation while receiving an NMBA?
They cannot breathe or protect their airway.
Why is prolonged 0/4 paralysis undesirable?
Increased risk of muscle atrophy and prolonged weakness.
A patient is intubated and receiving: rocuronium infusion, propofol, and fentanyl
During suctioning, there is no cough or gag reflex.
Why this expected?
Rocuronium paralyzes all skeletal muscles, including the diaphragm, pharyngeal muscles, and cough muscles. The absence of a cough or gag is expected while the patient is pharmacologically paralyzed.