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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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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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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...
1.0K
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

2.8K
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...
2.8K
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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General Anesthesia: Overview01:24

General Anesthesia: Overview

1.1K
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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Regional anesthesia in pediatrics: marching forward.

Karen R Boretsky1

  • 1Boston Children's Hospital, Boston, Massachusetts, USA.

Current Opinion in Anaesthesiology
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Paediatric regional anesthesia offers effective pain relief and is safe for children, with peripheral nerve blocks showing better outcomes than neuraxial blocks. More research is needed to optimize its use in pediatric surgical and non-surgical pain management.

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Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Regional Anesthesia Techniques

Background:

  • Historically, pediatric regional anesthesia relied on adult data.
  • Recent literature provides pediatric-specific risks, benefits, and technological impacts.
  • Growing evidence supports well-tolerated and effective pediatric regional anesthesia.

Purpose of the Study:

  • To review new data and trends in pediatric regional anesthesia.
  • To highlight advancements in techniques and technologies.
  • To inform optimal pain management strategies for children.

Main Methods:

  • Review of recent literature and databases on pediatric regional anesthesia.
  • Analysis of safety and efficacy data from over 46,000 procedures.
  • Evaluation of peripheral versus neuraxial nerve blocks and ultrasound guidance.

Main Results:

  • Pediatric regional anesthesia demonstrates excellent pain relief and overall safety.
  • Peripheral nerve blocks are safer and have lower failure rates than neuraxial blocks.
  • Ultrasound guidance, novel peripheral blocks, and perineural catheters enhance safety and efficacy.

Conclusions:

  • Pediatric-specific data are available to guide pain management.
  • The literature on pediatric regional anesthesia requires further development compared to adult data.
  • Additional studies are necessary for informed decision-making in pediatric pain management.