· Intro
· Table
· Graph
· Implications
Definitions |
· ED95: dose that produces 95% depression of single twitch height in adductor pollicis · 2 x ED95: intubating dose |
Summary |
Adductor pollicis vs diaphragm/larynx: · Slower onset · Greater peak effect · Slower offset |
|
Diaphragm and Larynx (D&L) Corrugator supercilii (CS) |
Adductor pollicis (AP) |
Physiology: |
|
|
-Blood flow |
↑ |
↓ |
-ACh release |
↑ |
↓ |
-AChR density |
↑ |
↓ |
-AChE activity |
↑ |
↓ |
Clinical effect: |
|
|
-Onset speed |
↑ (25% faster) |
↓ |
-Peak effect |
↓ |
↑ |
-Offset speed |
↑ (33-50% faster) |
↓ |
Where to look |
· CS: medial eyebrow (not orbicularis oculi) · AP: thumb & forefinger (not hypothenar eminence) |
Induction |
· CS: intubate at TOF count = 0 · AP: intubate at TOF count = 1 (?) |
Maintenance |
If immobility essential: · CS: titrate against TOF count = 0 · AP: titrate against PTC · Administer relaxant by infusion |
Emergence |
· CS: ahead of D&L. TOF count by inspection. -> risk of residual curarisation · AP: lag behind D&L. TOF ratio by accelerometry. -> Reversal at TOF count 4 -> Extubate at TOF ratio >0.9 |
https://link.springer.com/content/pdf/10.1007/BF03019373.pdf
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