Anaes Vivas · Neuromuscular blockade & reversal
Equipment viva — the train-of-four nerve stimulator
An equipment viva on the nerve stimulator — the principle (supramaximal stimulation of a peripheral nerve, observation of the muscle response), the train-of-four and post-tetanic count patterns, quantitative (acceleromyography) versus qualitative assessment, and the 0.9 recovery threshold. Anchored to the Naguib monitoring consensus.
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ANZCAFRCAABAEDAIC
Prompt
A peripheral nerve stimulator with surface electrodes applied over the ulnar nerve at the wrist, displaying a train-of-four stimulation mode.
Stimulus
A peripheral nerve stimulator delivering a supramaximal electrical stimulus to a peripheral nerve (classically the ulnar nerve at the wrist, observing the adductor pollicis), in a train-of-four mode. The examiner asks you to describe the device, its patterns of stimulation, and how it is used to assess the depth of a neuromuscular block.[6]
References2ShowHide
- [5]Naguib M, Brull SJ, Kopman AF, Hunter JM, et al. Consensus Statement on Perioperative Use of Neuromuscular Monitoring. Anesthesia & Analgesia, 2018.PMID 29200077
- [6]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.