Anesthesia: Hospital And Specialty Cycle Quiz!

For Continuous Infusion of Rocuronium, If rocuronium bromide is administered by continuous infusion, it is recommended to give a loading dose of 0.6 mg.kg-1 rocuronium bromide and, when neuromuscular block starts to recover, to start administration by infusion. The infusion rate should be adjusted to maintain twitch response at 10% of control twitch height or to maintain 1 to 2 responses to train of four stimulation. In adults under intravenous anesthesia, the infusion rate required to maintain neuromuscular block at this level ranges from 0.3-0.6 mg.kg-1.h-1, and under inhalational anesthesia the infusion rate ranges from 0.3-0.4 mg.kg-1.h-1. Continuous monitoring of neuromuscular block is recommended since infusion rate requirements vary from patient to patient and with the anesthetic method used.

• True

• False

Following are the routes of Anesthesia, Except

• Intravenous Anesthesia

• Inhalation Anesthesia

• Oral Anesthesia

• Total Intravenous Anesthesia

• Non of Above

Succinylcholine belongs to which of the following groups of Neuromuscular Blocking Agent.

• Aminosteroid NMBA

• Benzyllisoquinolines NMBA

• Depolarizing NMBA

• Non-Depolarizing NMBA

According to American Society of Anesthesiologists, ASA-3 assign for the physical status who are;

• Patients with Mild Systemic Disease

• Normal Healthy Person with no significant illness or disability

• Patients with Severe uncontrolled medical problems that are life threatening

• Patients with severe systemic disease that effect their daily life but not life threatening

• A brain dead person being taken for Organ donation surgery

For Maintenance dose of Rocuronium, The recommended maintenance dose is 0.15 mg.kg-1 rocuronium bromide; in the case of long-term inhalational anesthesia, this should be reduced to 0.075-0.1 mg.kg-1 rocuronium bromide. The maintenance doses should best be given when twitch height has recovered to 25% of control twitch height, or when 2 to 3 responses to a train of four stimulation are present.

• True

• False

Select the Single best for Rocuronium:

• Rocuronium launched in 1977

• The experience with rocuronium bromide in rapid sequence induction in pediatric patients is limited. Rocuronium bromide is therefore not recommended for facilitating tracheal intubation conditions during rapid sequence induction in pediatric patients

• In pediatric population, Rocuronium is the only option for Anesthetist

PACU means

The Triad of Anesthesia include following, Except

• Analgesia

• Sleep / Hypnosis

• Muscle Relaxation

• Memory Loss

• Non of Above

The best explanation for Anesthesia is...

• Irreversible Loss of Feeling or Sensation in all parts of body

• Reversible Loss of Feeling or Sensation in part of body

• Reversible Loss of Feeling or Sensation in All or Part of Body

• All or Above

Following are true for Rocuronium Bromide, Except.

• Indicated as adjunct to general anesthesia to facilitate routine Endotracheal Intubation to provide skeletal muscle relaxation during surgery or mechanical ventilation

• Indicated as adjunct to general anesthesia to facilitate Rapid Sequence Intubation to provide skeletal muscle relaxation during surgery or mechanical ventilation

• Rocuronium bromide is a nondepolarizing neuromuscular blocking agent with rapid to intermediate onset and an intermediate duration of action, depending on dose used

• Rocuronium has its effect on Conciousness, pain threshold, thinking ability and memory.

• Route of administration is Intravenous.

For Obese Patients, When used in overweight or obese patients (defined as patients with a body weight of 30% or more above ideal body weight) doses should be reduced taking into account ideal body weight.

• True

• False

Which of the following are the Strengths of Cis-atracurium, Except

• Organ-independent elimination (less prolonged recovery in elderly and renal/hepatic impaired)

• No significant histamine release

• Slow onset

• Suitable for CV-unstable and atopic patients

• Ready to Use

• Non of Above

Acetylcholine is one of the most important Neurotransmitters, made up of Acetyl Co-A and Choline Molecules. Which of the following is it's the site of release, at Neuromuscular junction?

• Presynaptic Neuromuscular Vasicles

• Post-synaptic Nicotinic receptor sites

• Inter-synaptic Membrane

• I dont know

• All of Above

Total clinical Duration...

• Time (min) from end of injection till recovery of neuromuscular transmission (twitch height) to a level of 90% of control

• Time between start of injection and the first moment at which endotracheal intubation can be performed

• Time between end of injection and first mooment at which endotracheal intubation can be preformed

• Time (min) from start of injection till recovery of neuromuscular transmission (twitch height) to a level of 90% of control

• I dont Know

• Non of above

The Use of Rocuronium in Hepatic and Renal Insufficiency:

• The standard intubation dose for geriatric patients and patients with hepatic and/or biliary tract disease and/or renal failure during routine anesthesia is 0.6 mg.kg-1 rocuronium bromide

• A dose of 0.6 mg.kg-1 should be considered for rapid sequence induction of anesthesia in patients in which a prolonged duration of action is expected

• Regardless of the anesthetic technique used, the recommended maintenance dose for these patients is 0.075-0.1 mg.kg-1 rocuronium bromide, and the recommended infusion rate is 0.3-0.4 mg.kg-1.h-1

• The dose of Rocuronium should be same as of Normal healthy adult, as it will not effect the Liver enzymes and Renal function

Please select the true statement for Rocuronium:

• The standard intubating dose during routine anesthesia is 0.6 mg.kg-1 rocuronium bromide, after which adequate intubation conditions are established within 60 seconds in nearly all patients

• A dose of 1.0 mg.kg-1 of rocuronium bromide is recommended for facilitating tracheal intubation conditions during rapid sequence induction of anesthesia

• If a dose of 0.6 mg.kg-1 rocuronium bromide is used for rapid sequence induction of anesthesia, it is recommended to intubate the patient 90 seconds after administration of rocuronium bromide

• Higher dose of rocuronium is needed if the anesthetist is willing for the short recovery

Regarding Rocuronium in Pediatric Population:

• For infants (28 days-23 months), children (2-11 years) and adolescents (12- 18 years) the recommended intubation dose during routine anesthesia and maintenance dose are similar to those in adults.

• For continuous infusion in pediatrics, the infusion rates, with exception of children, are the same as for adults

• There are insufficient data to support dose recommendations for the use of rocuronium bromide in neonates (0-1 month).

• The experience with rocuronium bromide in rapid sequence induction in pediatric patients is limited. Rocuronium bromide is therefore not recommended for facilitating tracheal intubation conditions during rapid sequence induction in pediatric patients.

Regarding Rocuronium in Pregnancy and Cesarean section:

• For rocuronium bromide, no clinical data on exposed pregnancies are available. Caution should be exercised when prescribing Esmeron to pregnant women.

• In patients undergoing Cesarean section, Esmeron can be used as part of a rapid sequence induction technique, provided no intubation difficulties are anticipated and a sufficient dose of anesthetic agent is administered

• Esmeron, administered in doses of 0.6 mg.kg-1, has been shown to be safe in parturients undergoing Cesarean section

• Esmeron does not affect Apgar score, fetal muscle tone nor cardiorespiratory adaptation.

• Only a dose of 0.6 mg.kg-1 is recommended in this patient group.

• Rocuronium should be given to lactating women only when the attending physician decides that the benefits outweigh the risks.

Select True options from the below statements:

• Rocuronium is fully reversable from any depth of block with the use of Sugammadex

• Sugammadex works with any type of Neuromuscular Blocker

• Sugammadex and Cisatracurium is the one of the ideal choices for Laproscopic Surgeries

• Sugammadex is modified cyclodextrin and not new to our human body

• There are many Specific Reversle agents for neuromuscular block available in the market

• Sugammdex can be a life saver in Cannot Intubate, Cannot Ventilate Situations

• Route of administration for Sugammadex is Intra Muscular

• Rocuronium in Normal doses can effect the normal Cardio pulmonary fuctions

Regarding Suxamethonium (Anectin)

• Ultra short duration of Action

• Short Recovery

• Low Cost

• Can be fully reversed spontaneously

• Ideal for Rapid sequence intubation despite of inavailability of reversal

• Suitable for short procedures

• Incidence of having higer Intragastric, Intracranial and Intraocular Pressure

• Belongs to Non-Depolarizing neuromuscular blocking agents family

• Suitable for patients with severe burns, muscular dystrophies, and hyperkalemia

• Suitable for patients with renal or hepatic failure

Regarding Rocuronium Bromide

• Only rapid onset non-depolarizing NMBA – low risk of pulmonary aspiration/regurgitation and rapid intubation is possible

• Organ-Independent elimination

• Flexible dosing – easy to titrate

• Fully Reversible

• In solution – stable up to 30C for 3 months

• No active metabolites

• Indicated for RSI

• Has significant effect on Heart Rate and Blood Pressure

• Has Effects on APGAR score, of New born

• Relatively Expensive, in comparison to Suxamethonium

Regarding Atracurium 

• Belongs to Non-Depolarizing Neuromuscular blocker family

• Having Organ-independent elimination (less prolonged recovery in elderly and renal/hepatic impaired)

• No significant Histamine release

• Stable in Vial

• Relatively Higher cost

• Produces Laudanosine, as a by product on long term usage

• Can be fully reversed from Deep and Intense Block with the Traditional reversing agent

• Highly predictable on Intubation time and Clinical Duration

• May cause increased heart rate and fall in blood pressure

Regarding Rocuronium

• Also known as Zemuron®, Eslax® and rocuronium

• Fast onset, intermediate-acting aminosteroid NMBA

• Binds nicotinic receptors at the neuromuscular junction – like ACh

• Flexible dosing - Not suitable for Short, intermediate and long procedures

• Good cardiovascular safety

• Suitable for a wide variety of patient and clinical settings

• Indicated In intensive care unit (ICU) To facilitate intubation and mechanical ventilation

• Does not significantly increase plasma histamine levels

• Possible prolongation of action in patients with clinically significant liver disease or renal failure

• In obese Patients Dose should be based on estimated Actual body weight

• Highly Inpredictable