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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local 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...
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local 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...
Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
Parenteral Anesthetics: Overview01:24

Parenteral 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.
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local 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...
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...

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Related Experiment Video

Updated: Jul 2, 2026

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
03:14

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

Published on: January 31, 2025

Why epidurals do not always work.

Katherine Arendt, Scott Segal

    Reviews in Obstetrics & Gynecology
    |September 5, 2008
    PubMed
    Summary
    This summary is machine-generated.

    Most epidural catheters provide effective labor analgesia. This review covers neuraxial labor analgesia basics, failure causes, and strategies for managing poorly functioning epidural catheters.

    Keywords:
    Combined spinal epidural techniqueDural punctureEpidural failureNeuraxial labor analgesia

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    External Cephalic Version: Is it an Effective and Safe Procedure?
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    External Cephalic Version: Is it an Effective and Safe Procedure?

    Published on: June 6, 2020

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    Last Updated: Jul 2, 2026

    Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
    03:14

    Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

    Published on: January 31, 2025

    External Cephalic Version: Is it an Effective and Safe Procedure?
    08:49

    External Cephalic Version: Is it an Effective and Safe Procedure?

    Published on: June 6, 2020

    Area of Science:

    • Anesthesiology
    • Obstetrics
    • Pain Management

    Background:

    • Epidural analgesia is a cornerstone of labor pain management.
    • Successful epidural placement is crucial for effective pain relief during childbirth.
    • Catheter malposition or patient-specific factors can impede timely epidural block onset.

    Purpose of the Study:

    • To review the fundamentals of neuraxial labor analgesia.
    • To identify common causes of epidural analgesia failure during labor.
    • To outline strategies for managing and rescuing "rescue" poorly functioning epidural catheters.

    Main Methods:

    • Review of existing literature on epidural catheter placement and function in labor.
    • Analysis of factors contributing to delayed or inadequate epidural analgesia.
    • Discussion of anesthesiologist techniques for troubleshooting and optimizing epidural catheter performance.

    Main Results:

    • The majority of epidural catheters achieve satisfactory labor analgesia.
    • Factors such as incorrect catheter placement, unique patient anatomy, and rapid labor progression can lead to "failure to set up" or delayed onset.
    • Various "rescue" techniques exist to manage malfunctioning epidural catheters.

    Conclusions:

    • Understanding the causes of epidural analgesia failure is key to effective management.
    • Anesthesiologists utilize specific strategies to "rescue" poorly functioning epidural catheters, ensuring continued labor pain relief.
    • Optimizing epidural catheter function is vital for satisfactory patient outcomes during childbirth.