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Related Concept Videos

General Anesthesia: Overview01:24

General Anesthesia: Overview

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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 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.
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

Local Anesthetics: Clinical Application as Spinal Anesthesia

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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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Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

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Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
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Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

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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.
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Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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Office-based anesthesia: safety and outcomes.

Fred E Shapiro1, Nathan Punwani, Noah M Rosenberg

  • 1From the Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia; Department of Family Medicine and Community Health, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts; First Colonies Anesthesia Associates, Frederick, Maryland; Department of Anesthesiology, SUNY Downstate Medical Center, Brooklyn, New York; and Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts.

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Summary

Office-based anesthesia (OBA) is growing, with studies showing comparable safety to hospitals when accredited. Implementing safety protocols is crucial for minimizing patient risks in this evolving field.

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Area of Science:

  • Anesthesiology
  • Ambulatory Surgery
  • Healthcare Management

Background:

  • Office-based anesthesia (OBA) has emerged as a subspecialty due to increased office-based procedures.
  • Innovations in procedures, drugs, reimbursement, and patient convenience drive OBA growth.
  • Limited randomized controlled trials exist; studies are primarily retrospective.

Purpose of the Study:

  • To explore trends in office-based anesthesia.
  • To analyze the implications of OBA for patient safety.
  • To identify strategies for minimizing complications and mortality in OBA.

Main Methods:

  • Review of existing literature on office-based anesthesia.
  • Analysis of retrospective studies on patient outcomes.
  • Exploration of safety strategies and regulatory trends.

Main Results:

  • Early literature raised safety concerns, but recent data indicate comparable safety to hospitals and ASCs for accredited facilities with certified providers.
  • Accreditation, board certification, proper patient/procedure selection, and adherence to guidelines enhance OBA safety.
  • Regulatory oversight of the ambulatory setting is increasing.

Conclusions:

  • Office-based anesthesia can be safe and effective when appropriate quality and safety measures are implemented.
  • Continued focus on patient selection, provider credentialing, and facility standards is essential for safe OBA practice.
  • Evolving regulatory landscapes necessitate robust safety protocols to ensure patient well-being in office-based settings.