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Local Anesthetics: Clinical Application as Epidural Anesthesia

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...

Parenteral Anesthetics: Overview

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.

General Anesthesia: Overview

General 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...

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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...

Local Anesthetics: Clinical Application as Spinal Anesthesia

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...

Inhalational Anesthetics: Overview

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...

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Anesthesia for ritual circumcision in neonates.

Michael Rosen¹

¹University of Wales, Cardiff, Wales, UK. rosen@mrosen.plus.com

Paediatric Anaesthesia

|January 5, 2011

Summary

Anesthesia is recommended for neonatal circumcision by medical and religious authorities. While challenges exist in providing anesthesia, topical creams like EMLA offer a practical solution for pain management during the procedure.

Area of Science:

Medical ethics
Pediatric surgery
Anesthesiology

Background:

Neonatal circumcision is performed globally, often without anesthesia.
While recommended for Muslims, circumcision is not a religious mandate.
Jewish law mandates circumcision (Bris) on the eighth day by a mohel.

Purpose of the Study:

To determine medical and religious consensus on anesthesia for neonatal circumcision.
To investigate pediatric surgical and anesthetic bodies' views on anesthesia requirements and objections.

Main Methods:

Survey of medical authorities regarding anesthesia for neonatal circumcision.
Consultation with religious authorities on the necessity and objections to anesthesia.

Main Results:

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Universal agreement among medical authorities on the need for anesthesia.
No religious objections found regarding anesthesia administration.
Challenges identified in meeting 'any day' anesthesia requests due to a shortage of pediatric anesthetists.
Local anesthesia deemed suitable but requires specialized skills.

Conclusions:

Anesthesia is strongly recommended for neonatal circumcision.
Difficulties in providing professional anesthesia services are anticipated.
EMLA cream is considered the most practical option, despite partial effectiveness.
A parent-focused website demonstrating application could increase EMLA cream usage.