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Related Concept Videos

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...
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General Anesthesia: Overview01:24

General Anesthesia: Overview

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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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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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Stages of General Anesthesia01:22

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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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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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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia.

Ivan Veličković1, Borislava Pujic2, Charles W Baysinger3

  • 1Department of Anesthesiology, SUNY Downstate Medical Center, Brooklyn, NY, United States.

Frontiers in Medicine
|September 2, 2017
PubMed
Summary

Continuous spinal anesthesia (CSA) is underutilized in obstetrics due to post-dural puncture headache (PDPH) risks. However, CSA offers benefits for specific patient groups and accidental dural punctures, with rapid analgesia extension.

Keywords:
intrathecal catheterslabor analgesianeuraxial blockadeobstetric anesthesiapost-dural puncture headachespinal catheters

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Area of Science:

  • Anesthesiology
  • Obstetrics
  • Neurosurgery

Background:

  • Continuous spinal anesthesia (CSA) use in obstetrics is limited by high post-dural puncture headache (PDPH) rates.
  • Existing equipment and techniques have not substantially mitigated PDPH risks.
  • CSA presents an alternative anesthetic option for specific high-risk obstetric populations.

Purpose of the Study:

  • To evaluate the role and potential benefits of continuous spinal anesthesia (CSA) in obstetric care.
  • To identify patient subgroups and scenarios where CSA may be advantageous over traditional epidural anesthesia.
  • To assess the impact of intrathecal catheters on PDPH incidence and analgesia efficacy in CSA.

Main Methods:

  • Review of existing literature on continuous spinal anesthesia (CSA) in obstetrics.
  • Analysis of PDPH risk factors and mitigation strategies associated with epidural and spinal techniques.
  • Comparison of CSA and continuous epidural techniques regarding drug dosage, onset, and extension of analgesia.

Main Results:

  • CSA adoption in obstetrics remains slow due to significant PDPH risks.
  • CSA is a viable alternative for morbidly obese, cardiac patients, and those with prior spinal surgery.
  • Intrathecal catheters may reduce PDPH after accidental dural puncture, warranting consideration of CSA.
  • CSA allows for smaller drug doses and faster analgesia extension for emergency cesarean delivery.

Conclusions:

  • Continuous spinal anesthesia (CSA) offers critical advantages in select obstetric patients despite PDPH concerns.
  • The use of intrathecal catheters with CSA may reduce PDPH incidence, making it a safer option.
  • CSA should be strongly considered in cases of accidental dural puncture and for specific high-risk parturients.