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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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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.
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...
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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 Intravenous Regional Anesthesia01:16

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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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Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

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A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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Brain Abscess l: Introduction01:26

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A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial...
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An epidural blood patch causing acute neurologic dysfunction necessitating a decompressive laminectomy.

Sonya P Mehta1, Bart P Keogh, Arthur M Lam

  • 1From the *Neuroanesthesia and Neurocritical Care, Swedish Medical Center, Seattle; †Physician Anesthesia Service, Seattle; ‡Radiology, Swedish Neuroscience Institute, Swedish Medical Center, Seattle; and §Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.

Regional Anesthesia and Pain Medicine
|December 7, 2013
PubMed
Summary
This summary is machine-generated.

A rare complication of epidural blood patch (EDBP) is spinal cord compression from an epidural hematoma, leading to cauda equina syndrome. Prompt surgical decompression is crucial for neurological recovery.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Anesthesiology

Background:

  • Epidural blood patches (EBP) are used to treat cerebrospinal fluid leaks.
  • Spinal cord or nerve root compression is a potential risk of EBP due to injected blood volume.

Observation:

  • A patient developed spinal cord compression and cauda equina syndrome after a second EBP, despite fluoroscopic guidance.
  • Radiologic evidence confirmed an epidural hematoma, necessitating emergent decompressive laminectomy.

Findings:

  • Cauda equina syndrome can arise from epidural hematoma following EBP, even with imaging guidance.
  • Surgical evacuation of the hematoma led to partial recovery of neurological function.

Implications:

  • Early recognition and surgical intervention are vital for managing this rare EBP complication.
  • While rare, this complication should not preclude the use of EBP when indicated.