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Related Concept Videos

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

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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

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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Kidney Transplant II: Surgical Procedure01:26

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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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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Organ Ischemia-Reperfusion Injury by Simulating Hemodynamic Changes in Rat Liver Transplant Model
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Anesthesia for liver transplantation.

Aparna Dalal1

  • 1Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York City, NY 10029.

Transplantation Reviews (Orlando, Fla.)
|June 30, 2015
PubMed
Summary
This summary is machine-generated.

Anesthesia management for liver transplantation is complex due to end-stage liver disease (ESLD) complications. Careful anesthetic and perioperative agent selection, advanced monitoring, and surgical technique management are crucial for patient outcomes.

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Area of Science:

  • Anesthesiology
  • Hepatology
  • Transplant Surgery

Background:

  • Patients with end-stage liver disease (ESLD) present multifaceted medical challenges impacting anesthetic management.
  • ESLD alters pharmacokinetics and pharmacodynamics of anesthetic agents, necessitating specialized approaches.
  • Comorbidities like cirrhotic cardiomyopathy, hepatopulmonary syndrome, and coagulopathies complicate perioperative care.

Purpose of the Study:

  • To provide a comprehensive overview of anesthesia management in liver transplantation.
  • To highlight the complexities and critical considerations for perioperative care in ESLD patients undergoing liver transplant.
  • To discuss the role of various agents, monitoring techniques, and surgical strategies.

Main Methods:

  • Review of anesthetic agents and their impact on hepatic blood flow and drug metabolism in ESLD.
  • Discussion of essential perioperative medications and their indications.
  • Overview of advanced monitoring modalities including Thromboelastography (TEG), Transcranial Doppler (TCD), and Transesophageal Echocardiography (TEE).
  • Description of surgical techniques such as inferior vena cava (IVC) occlusion and venovenous bypass (VVBP).

Main Results:

  • Anesthetic agents require careful selection and dosing due to altered metabolism in ESLD.
  • Perioperative use of specific agents (e.g., nitric oxide, fibrinogen concentrates) is vital.
  • Advanced monitoring (TEG, TCD, TEE) aids in managing hemostasis, coagulation, and hemodynamic stability.
  • Management of post reperfusion syndrome (PRS) is critical to prevent arrhythmias and cardiac arrest.
  • Anesthesia for living liver transplant donors and post-operative pain management are also addressed.

Conclusions:

  • Liver transplantation anesthesia demands a multidisciplinary approach, integrating knowledge of ESLD pathophysiology and surgical requirements.
  • Meticulous attention to anesthetic drug selection, fluid management, coagulation, and hemodynamic stability is paramount.
  • Effective use of advanced monitoring and timely intervention for complications like PRS are key to successful outcomes.