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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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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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General Anesthesia: Overview01:24

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

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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...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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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.
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Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

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Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
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Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

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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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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
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Regional anaesthesia in thyroid surgery.

Navaid Akhtar1, S Akbar Abbas

  • 1Department of Anaesthesiology and Pain Management, Patel Hospital, Karachi.

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
|December 6, 2013
PubMed
Summary
This summary is machine-generated.

Bilateral cervical plexus block offers a safe alternative to general anesthesia for thyroidectomy in high-risk patients. This regional anesthesia technique provided pain-free surgery for a medically compromised patient with cardiac failure.

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Area of Science:

  • Anesthesiology
  • Surgical Oncology

Background:

  • Thyroidectomy is typically performed under general anesthesia with endotracheal intubation.
  • Bilateral cervical plexus block is an alternative anesthetic technique, occasionally used globally for thyroidectomy, especially for patients with cardio-respiratory compromise or specific preferences.

Observation:

  • This case report details the first instance of thyroidectomy performed solely under bilateral cervical plexus block in Pakistan.
  • The patient presented with thyroid cancer and severe cardiac failure (ejection fraction 25%), making general anesthesia high-risk.

Findings:

  • The total thyroidectomy was successfully completed using bilateral cervical plexus block with monitored anesthesia care.
  • The patient remained pain-free throughout the procedure, requiring no additional local anesthetic infiltration.
  • The patient experienced no morbidity and remained hemodynamically stable post-operatively.

Implications:

  • Regional anesthesia with monitored anesthesia care can be a safer alternative to general anesthesia for high-risk thyroidectomy candidates.
  • This approach may be suitable for selected patients with significant co-existing medical conditions, improving surgical outcomes.
  • The successful application of bilateral cervical plexus block in this case highlights its potential in resource-limited settings for complex surgical cases.