Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section A. Monitoring the Anesthesia Patient > Chapter 33. Monitoring and Managing Neuromuscular Blockade Richard M. Pino, MD, PhD, and Hassan H. Ali, MD

Key Points

"1. Muscle response can be measured by mechanomyography, electromyography, acceleromyography, and direct palpation.

2. Commonly used patterns of stimulation are single twitch, train of four, double burst, tetanic, and posttetanic count.

3. Clinical criteria, in addition to evoked responses, should be used to assess recovery of neuromuscular blockade.

4. Pharmacokinetics is the mathematical description of the relationship between time and the plasma concentration of a drug and its metabolites. Pharmacodynamics is the measurement of what the drug does in the body.

5. Reversal agents increase the concentration of acetylcholine in the junctional clefts to compete with the neuromuscular blocking drug (NMBD) to restore muscle activity.

6. Succinylcholine, the depolarizing NMBD, is metabolized by plasma cholinesterase. Atypical pseudocholinesterases cannot metabolize pseudocholinesterase at a normal rate, and prolonged neuromuscular blockade may result.

7. Immobility, prolonged use of NMBDs, and upper and lower motor neuron disease may cause the proliferation of extrajunctional receptors. These receptors affect severe hyperkalemia when stimulated with succinylcholine.

8. Nondepolarizing NMBDs are benzylisoquinoline (mivacurium, atracurium, cisatracurium, doxacurium) and..."