RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Pharmacology
Easy
Administration of neuromuscular blocking agents before ECT can cause?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Explanation
- Neuromuscular blocking agents (NMBAs), such as succinylcholine, are administered to induce paralysis of all skeletal muscles.
- This paralysis includes the diaphragm and intercostal muscles, which are essential for spontaneous breathing.
- The paralysis of these respiratory muscles leads to a temporary, expected period of apnea or severe respiratory difficulty.
- This effect is managed by the anesthesia team, who provide oxygenation and ventilation until the patient can breathe independently again.
Why Other Options Were Wrong
- Option A: Dry mouth is a common side effect of anticholinergic medications (e.g., atropine, glycopyrrolate), which are often given before ECT to reduce secretions, not a direct effect of neuromuscular blockers.
- Option C: Neuromuscular blockers do not affect glandular secretions. In fact, anticholinergic agents are administered specifically to decrease secretions and prevent aspiration.
- Option D: The seizure is the intended therapeutic outcome of the ECT electrical stimulus. Neuromuscular blockers are given to prevent the physical manifestations (motor convulsions) of the seizure and protect the patient from injury.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological effects of neuromuscular blocking agents in Electroconvulsive Therapy (ECT) as background academic context rather than a clinical decision trigger.
- The primary nursing and anesthesia responsibility during ECT is vigilant airway management. The NMBA-induced apnea is an expected, managed event, not an unexpected complication.
- Nurses must ensure that emergency airway equipment, including a suction machine, oxygen source, bag-valve mask, and intubation kit, is immediately available at the bedside for every ECT procedure.
- What if? If a patient has an undiagnosed pseudocholinesterase deficiency, the metabolism of succinylcholine is significantly slowed, leading to prolonged apnea and paralysis. The team must be prepared to provide extended mechanical ventilation and close monitoring until muscle function returns.
How to Approach the Question
- First, identify the core of the question: the effect of a specific drug class (neuromuscular blocking agents) in a specific procedure (ECT).
- Recall the primary mechanism of action for neuromuscular blockers. Their name indicates their function: they block neuromuscular transmission, causing muscle paralysis.
- Consider all types of skeletal muscle. This includes not just limb muscles but also the diaphragm and intercostal muscles, which are vital for breathing.
- Evaluate each option based on this primary mechanism. Muscle paralysis directly impacts the ability to breathe.
- Differentiate the effects of the NMBA from other drugs used in ECT (anesthetics, anticholinergics) and from the ECT procedure itself (the seizure) to eliminate the incorrect options.
Concept Tested & Keywords
- Concept Tested: Pharmacological effects of neuromuscular blocking agents in Electroconvulsive Therapy (ECT)
- Stem keywords: neuromuscular blocking agents, ECT, administration
- Lead-in keywords: can cause
- Negative lead-in flag: false
Question ID
Qb4GpHbyWSIjwZ12X6oXp5
Reference Book
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2303-2305
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 11193-11195
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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