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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 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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Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action01:17

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action

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Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
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Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

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

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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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Related Experiment Video

Updated: Apr 16, 2026

External Cephalic Version: Is it an Effective and Safe Procedure?
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Neuraxial blockade for external cephalic version: Cost analysis.

Kelly Yamasato1, Bliss Kaneshiro1, Jennifer Salcedo1

  • 1Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.

The Journal of Obstetrics and Gynaecology Research
|March 17, 2015
PubMed
Summary
This summary is machine-generated.

Neuraxial blockade during external cephalic version (ECV) has minimal cost impact for hospitals and insurers. This anesthesia method also significantly reduces cesarean delivery rates, improving outcomes for mothers and babies.

Keywords:
breechcesarean deliverycostexternal cephalic versionneuraxial blockade

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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Health Economics

Background:

  • External cephalic version (ECV) is a procedure to turn a fetus from a breech to a cephalic presentation.
  • Neuraxial blockade (epidural or spinal anesthesia/analgesia) is associated with increased ECV success rates.
  • The cost-effectiveness of neuraxial blockade for ECV is not well-established from institutional perspectives.

Purpose of the Study:

  • To conduct a cost analysis of neuraxial blockade use during ECV from hospital and insurance payer viewpoints.
  • To estimate the impact of neuraxial blockade on cesarean delivery rates in the context of ECV.

Main Methods:

  • A decision-analysis model was developed incorporating prenatal and delivery admission costs and probabilities.
  • Model inputs were sourced from literature, national databases, and local cost data.
  • Sensitivity analyses (univariate, bivariate) and Monte Carlo simulations were used to evaluate model robustness.

Main Results:

  • Neuraxial blockade was found to be cost-saving for hospitals ($30/delivery) and insurers ($539/delivery) in baseline scenarios.
  • Sensitivity analyses revealed that the model's cost outcomes were sensitive to multiple variables.
  • Monte Carlo simulations indicated neuraxial blockade could be more costly in approximately 50% of simulated scenarios.
  • Routine neuraxial blockade for ECV prevented an estimated 17 cesarean deliveries per 100 attempted ECVs.

Conclusions:

  • Neuraxial blockade during ECV is associated with minor cost variations for hospitals and insurers.
  • The use of neuraxial blockade in conjunction with ECV is effective in reducing cesarean delivery rates.