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

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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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Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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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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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Anticoagulation and Neuraxial/Peripheral Anesthesia.

Mudit Kaushal1, Ryan E Rubin2, Alan D Kaye2

  • 1Department of Anesthesiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.

Anesthesiology Clinics
|May 21, 2017
PubMed
Summary
This summary is machine-generated.

Novel anticoagulants (NAGs) are replacing vitamin K antagonists but complicate regional anesthesia. This review offers guidance for clinicians managing patients on these new drugs.

Keywords:
AnticoagulationAntiplateletCoumadinDirect thrombin inhibitorsFactor Xa inhibitorsNeuraxialRegional

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Area of Science:

  • Anesthesiology
  • Hematology
  • Pharmacology

Background:

  • Novel anticoagulants (NAGs) are increasingly used, posing challenges for pre-procedure evaluation in regional anesthesia.
  • Lack of established monitoring tests and limited clinical experience with NAGs necessitate clear guidelines.
  • Existing guidelines for heparin, LMWH, and antiplatelet agents provide a basis for comparison.

Purpose of the Study:

  • To review the literature on novel anticoagulants (NAGs) relevant to regional anesthesia.
  • To provide a clinical reference for managing patients on NAGs undergoing regional anesthesia.
  • To compare NAGs with traditional anticoagulants and antiplatelet agents.

Main Methods:

  • Literature review encompassing hematology, orthopedics, and anesthesiology.
  • Analysis of existing American Society of Regional Anesthesia guidelines.
  • Synthesis of information on novel anticoagulant pharmacology and clinical application.

Main Results:

  • Novel anticoagulants (NAGs) present unique challenges in pre-anesthesia assessment due to monitoring difficulties.
  • A comprehensive understanding of NAGs is crucial for safe regional anesthesia practices.
  • Guidelines for traditional anticoagulants offer a framework but require adaptation for NAGs.

Conclusions:

  • Clinicians need updated guidance for managing patients on novel anticoagulants (NAGs) undergoing regional anesthesia.
  • Further research and standardized monitoring protocols for NAGs are essential.
  • This review aims to bridge the knowledge gap for anesthesiologists and other clinicians.