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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...
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 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...
General Anesthesia: Overview01:24

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: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...

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Related Experiment Video

Updated: May 30, 2026

Mouse Model of Surgical Uterine Injury and Subsequent Pregnancy Outcomes
04:08

Mouse Model of Surgical Uterine Injury and Subsequent Pregnancy Outcomes

Published on: June 27, 2025

Anesthetic considerations for placenta accreta.

S J Lilker1, R A Meyer, K N Downey

  • 1Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada.

International Journal of Obstetric Anesthesia
|August 16, 2011
PubMed
Summary
This summary is machine-generated.

Placenta accreta management has evolved from cesarean hysterectomy to uterine preservation techniques. Neuraxial anesthesia, particularly epidural anesthesia, is increasingly used and well-tolerated for cesarean delivery in placenta accreta cases, even with significant blood loss.

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Published on: September 10, 2018

Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Maternal-Fetal Medicine

Background:

  • Placenta accreta diagnosis antenatally often led to cesarean hysterectomy.
  • Uterine preservation techniques are emerging, with uterine artery embolization as an adjuvant.
  • Multidisciplinary approaches have enabled development of anesthetic strategies for placenta accreta.

Purpose of the Study:

  • To review anesthetic techniques used in placenta accreta cases.
  • To evaluate outcomes including blood loss and need for blood products.
  • To assess the feasibility of uterine preservation surgery under different anesthetic regimens.

Main Methods:

  • Retrospective review of 23 placenta accreta cases from 2000-2008.
  • Analysis of anesthetic techniques (epidural, general, neuraxial).
  • Recording of estimated blood loss, blood product requirements, and postoperative disposition.

Main Results:

  • Neuraxial anesthesia was planned in 17 cases, with 29% requiring conversion to general anesthesia due to blood loss.
  • 39% of patients experienced >2L intraoperative blood loss, and 6 required transfusion.
  • 48% of patients underwent hysterectomy, with 7 on the day of delivery.

Conclusions:

  • Initial conservative anesthetic approaches (general anesthesia) for placenta accreta have evolved.
  • Neuraxial anesthesia (epidural) is now employed more frequently.
  • Appropriate management allows most patients to tolerate prolonged surgery and significant blood loss under epidural anesthesia.