Muscle relaxants: reversal timing: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Muscle relaxants: reversal timing

Sample item

When is neostigmine unlikely to reverse neuromuscular block effectively?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. During profound block with no response to train-of-four

Neostigmine has a ceiling effect and cannot overcome deep block, so reversal should be delayed until at least a train-of-four count of 2 or more. Sugammadex is the alternative in deep block.

Option by option

  • A. At a TOF ratio of 0.5

    A ratio of 0.5 is reversible.

  • B. When all four twitches are present

    With four twitches reversal is effective.

  • C. During profound block with no response to train-of-four (correct)

    Correct. Deep block cannot be overcome by neostigmine.

  • D. After TOF count of 4 with fade

    A count of 4 with fade is a good time for reversal.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, During profound block with no response to train-of-four. Neostigmine has a ceiling effect and cannot overcome deep block, so reversal should be delayed until at least a train-of-four count of 2 or more.

Why is "At a TOF ratio of 0.5" not the answer?

A ratio of 0.5 is reversible.

Why is "When all four twitches are present" not the answer?

With four twitches reversal is effective.

Why is "After TOF count of 4 with fade" not the answer?

A count of 4 with fade is a good time for reversal.

What concept does this question test?

It tests Muscle relaxants: reversal timing in Anaesthesia. Sugammadex is the alternative in deep block.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Muscle relaxants: reversal timing?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.