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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.
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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Parenteral Anesthetics: Overview01:24

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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: 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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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.
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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Obstetric analgesia - update 2016.

Michael Heesen1, Markus Klimek2

  • 1Department of Anaesthesia, Kantonsspital Baden, Im Ergel 1, 5404 Baden.

Journal of Perinatal Medicine
|July 9, 2016
PubMed
Summary
This summary is machine-generated.

This review covers neuraxial labor analgesia methods, including combined spinal-epidural and epidural techniques. It discusses advancements like computer-integrated patient-controlled epidural analgesia and addresses complications such as postdural puncture headache.

Keywords:
Epiduralinhalationalintravenousobese patientobstetric analgesia

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Area of Science:

  • Anesthesiology
  • Obstetrics
  • Pain Management

Background:

  • Neuraxial labor analgesia is commonly initiated using combined spinal-epidural (CSE) or stand-alone epidural techniques.
  • Recent advancements include computer-integrated patient-controlled epidural analgesia (CI-PCEA) and programmed intermittent epidural boluses (PIEB) for maintenance.
  • Potential complications like postdural puncture headache (PDPH) and epidural fever require clinical attention.

Purpose of the Study:

  • To review the pros and cons of different neuraxial labor analgesia techniques.
  • To discuss recent developments in the maintenance of labor analgesia.
  • To outline mechanisms and treatments for PDPH and epidural fever, and consider specific patient groups.

Main Methods:

  • Literature review of current practices and recent advancements in neuraxial labor analgesia.
  • Discussion of established and emerging techniques for analgesia maintenance.
  • Exploration of complications, specific patient considerations, and alternative analgesia methods.

Main Results:

  • CSE and epidural techniques offer distinct advantages and disadvantages for labor pain management.
  • CI-PCEA and PIEB represent evolving strategies for continuous neuraxial analgesia.
  • Understanding PDPH mechanisms and epidural fever is crucial for effective patient care.

Conclusions:

  • The review provides a comprehensive overview of neuraxial labor analgesia, highlighting established and novel approaches.
  • Management of complications and tailored approaches for specific populations, such as obese patients, are emphasized.
  • Emerging trends in obstetric analgesia, including the use of remifentanil and nitrous oxide, are also considered.