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Monday, December 15, 2008

“Train of four” is associated with Weaning of ventilation

Question 20
“Train of four” is associated with
a.       Mechanical ventilation
b.      Muscle relaxants
c.       Weaning of ventilation
d.      None of the above
Answer
b. Muscle relaxants
Reference
Katsung 9th Edition Page 435
Quality
Reader
QTDF
Katsung
Discussion
Assessment of Neuromuscular Transmission
Monitoring the effect of muscle relaxants during surgery (and recovery following the uise of cholinesterase inhibitors) typically involves the use of a device that produces transdermal electrical stimulation of one of the peripheral nerves to the hand and recording of the evoked contractions.
Explanation
Train of Four is A method for measuring magnitude and type of neuromuscular blockade, based upon the ratio of the amplitude of the fourth evoked mechanical response to the first one, when four supramaximal 2-Hz electrical currents are applied for 2 seconds to a peripheral motor nerve.
Comments
The three most commonly used patterns include
  1. Single twitch stimulation
  2. Train of four (TOF) Stimulation
  3. Tetanic Stimulation
Tips
Two newer modalities are available to monitor neuromuscular transmission : double burst stimulation and post titanic count

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