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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...
Multiple Sclerosis l: Introduction01:19

Multiple Sclerosis l: Introduction

Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
Classification of Skeletal Muscle Relaxants01:28

Classification of Skeletal Muscle Relaxants

Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
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...

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Obstetrical epidural and spinal anesthesia in multiple sclerosis.

Ellen Lu1, Yinshan Zhao, Leanne Dahlgren

  • 1Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Room S178, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.

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Obstetrical epidural anesthesia use was more common in multiparous women with multiple sclerosis (MS). Epidural use was less likely 5 to 10 years after MS onset, but spinal anesthesia use was similar to the general population.

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Area of Science:

  • Obstetrics and Gynecology
  • Neurology
  • Anesthesiology

Background:

  • Multiple sclerosis (MS) is a chronic neurological condition affecting women of reproductive age.
  • Understanding anesthesia use during delivery for women with MS is crucial for optimizing maternal and infant care.
  • Previous studies have yielded conflicting results regarding anesthesia choices in MS patients.

Purpose of the Study:

  • To investigate the utilization of epidural and spinal anesthesia in women with multiple sclerosis during childbirth.
  • To explore the relationship between anesthesia use and clinical factors of multiple sclerosis, including disease duration and disability.

Main Methods:

  • Retrospective cohort study linking British Columbia (BC) MS database with BC Perinatal Database Registry (1998-2009).
  • Compared epidural and spinal anesthesia use in women with MS versus the general population, adjusting for parity.
  • Examined associations between anesthesia use and MS disease duration and Expanded Disability Status Scale (EDSS) score.

Main Results:

  • Epidural anesthesia use was similar in nulliparous women but significantly higher in multiparous women with MS.
  • Spinal anesthesia use in cesarean deliveries was comparable between women with MS and the general population.
  • Women delivering 5 to <10 years post-MS onset were less likely to receive epidural anesthesia; EDSS score was not associated with anesthesia use.

Conclusions:

  • Epidural anesthesia use during obstetrics differs between women with MS and the general population, influenced by parity and disease duration.
  • Findings suggest a need for further investigation into anesthesia management for pregnant women with MS.
  • Anesthesia choices may be influenced by factors beyond disease severity, such as parity and time since MS diagnosis.