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Related Concept Videos

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: 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...
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: 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.
Stages of General Anesthesia01:22

Stages 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...

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[Comparative study on two total intravenous anesthesia techniques in complex spine surgery].

Xiu-li Meng1, Li-wei Wang, Yang Zhou

  • 1Department of Anaesthesiology, Peking University Third Hospital, Beijing, China.

Beijing Da Xue Xue Bao. Yi Xue Ban = Journal of Peking University. Health Sciences
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Target-controlled infusion (TCI) provided smoother anesthesia depth control than manual-controlled infusion (MCI) during spinal deformity surgery. Both methods ensured stable hemodynamics and successful spinal cord monitoring, with no significant differences in anesthetic agent use or recovery times.

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An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model
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Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Pharmacokinetics

Background:

  • Spinal deformity correction surgery requires precise anesthetic management.
  • Maintaining stable anesthesia depth is crucial for patient safety and surgical outcomes.
  • Target-controlled infusion (TCI) and manual-controlled infusion (MCI) are methods for administering propofol and remifentanil.

Purpose of the Study:

  • To compare the anesthesia profiles of TCI and MCI for propofol and remifentanil in spinal deformity correction surgery.
  • To evaluate the control of anesthesia depth and hemodynamic stability during intraoperative spinal cord monitoring.

Main Methods:

  • 160 patients undergoing kyphosis or scoliosis correction were randomized into TCI and MCI groups.
  • Anesthesia depth was monitored using Bispectral Index (BIS); hemodynamic parameters were maintained within 20% of baseline.
  • Comparisons included pump regulation time, BIS fluctuation, drug amounts, recovery times, and spinal cord monitoring success rates (SSEPs, MEPs, EMG).

Main Results:

  • TCI group showed significantly less pump regulation time and smaller BIS fluctuations compared to MCI (P<0.05).
  • No significant differences were found in the total amounts of propofol and remifentanil used, time to awake, or time to extubation.
  • Successful rates of somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) were comparable between the groups.

Conclusions:

  • Both TCI and MCI are effective for anesthesia in spinal deformity correction surgery.
  • TCI offers superior control in maintaining a smooth and steady anesthesia depth.
  • Neither method demonstrated a significant advantage in terms of drug consumption, recovery, or spinal cord monitoring efficacy.