NMB Quiz

A patient develops bradycardia after succinylcholine. Which premedication best prevents it?

• Atropine

• Glycopyrrolate

• Edrophonium

• Sugammadex

Which scenario most threatens safe re-paralysis after sugammadex use?

• Administering Rocuronium <24 hours post-sugammadex

• Giving Succinylcholine immediately after sugammadex

• Using Cisatracurium to re-paralyze

• Monitoring with AMG instead of MMG

A patient on prolonged vecuronium infusion needs reversal. The best agent is?

• Neostigmine 50ug/kg

• Edrophonium 1mg/kg

• Sugammadex 4mg/kg

• Pyridostigmine oral dose

In the context of rapid infusion, which physiologic change would least alter Hofmann-eliminated drugs?

• Hypothermia

• Acid-base derangement

• Multi-organ failure

• Altered pH and temperature

You must choose an NMB in sepsis. Which property matters most?

• Hepatic clearance rate

• Organ-independent elimination

• Presynaptic receptor affinity

• Volume of distribution

In patients with renal failure, sugammadex-rocuronium complexes accumulate. Which monitoring strategy best mitigates residual paralysis?

• Clinical assessment

• Peripheral nerve stimulator with subjective fade

• EMG with TOF >/=0.9

• Time-based extubation criteria

You need to quantify subtle residual paralysis (TOF 0.4-0.9). Which assessment is insensitive?

• TOF fade on peripheral nerve stimulator

• Quantitative EMG

• Double-burst stimulation

• Post-tetanic count

A new aminosteroid has prolonged half-life in hepatic impairment. Predict which dosage adjustment is required.

• Increase loading dose

• Decrease maintenance infusion rate

• No change

• Add neostigmine prophylactically

A patient on atropine presents for reversal with edrophonium. Which effect must you anticipate?

• Bradycardia

• No muscarinic side effects

• Increased salivation

• Hypertension

Compare neostigmine vs edrophonium for reversing a shallow cisatracurium block. Which is optimal?

• Neostigmine-for ceiling effect at minimal block

• Edrophonium-for fastest onset with minimal block

• Either-no difference at minimal block

• Neither-use sugammadex