Related Experiment Video
Updated: Jul 20, 2026
05:39
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
The critically ill patient and regional anesthesia
1Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. sebastian-schulz-stubner@uiowa.edu
Current Opinion in Anaesthesiology
|September 9, 2006
Summary
Regional anesthesia and analgesia offer benefits for critically ill patients, including improved function and comfort by reducing opioid use. However, risks like bleeding and toxicity must be carefully managed.
Area of Science:
- Critical Care Medicine
- Anesthesiology
- Surgical Patient Management
Background:
- Regional anesthesia and analgesia are increasingly considered for critically ill patients.
- Evidence for their use in intensive care unit (ICU) settings is limited.
Purpose of the Study:
- To review the indications, limitations, and practical aspects of regional anesthesia and analgesia in critically ill medical and surgical patients.
- To synthesize current knowledge on the application of these techniques in the ICU.
Main Methods:
- A comprehensive literature search was conducted using Medline and the Cochrane Library.
- Search terms included regional anesthesia, regional analgesia, critically ill, and nerve blocks.
- Evidence was primarily derived from case reports, cohort studies, and expert opinions due to a lack of dedicated ICU studies.
Main Results:
- No studies specifically designed for regional anesthesia and analgesia in the ICU were identified.
- Available data are extrapolated from perioperative management studies.
- Case reports and expert opinions suggest potential benefits but highlight significant limitations.
Conclusions:
- Regional anesthesia and analgesia can improve respiratory and bowel function, mental status, and patient comfort in the critically ill by reducing opioid requirements.
- Key limitations include increased bleeding risks, potential hemodynamic instability, challenges in neurological assessment, and local anesthetic toxicity.
Related Concept Videos
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
01:24General Anesthesia: Overview
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:22Stages of General Anesthesia
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...