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Related Concept Videos

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

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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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Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
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Depolarizing Blockers: Mechanism of Action01:28

Depolarizing Blockers: Mechanism of Action

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Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
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Depolarizing Blockers: Pharmocokinetics01:19

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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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Paravertebral Block for Thoracic Surgery.

Francine D'Ercole1, Harendra Arora2, Priya A Kumar2

  • 1Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC.

Journal of Cardiothoracic and Vascular Anesthesia
|November 25, 2017
PubMed
Summary
This summary is machine-generated.

Paravertebral blockade (PVB) offers effective anesthesia and pain management for thoracic surgery, comparable to thoracic epidural analgesia but with fewer side effects. This technique is versatile for unilateral or bilateral procedures, minimizing hypotension risks.

Keywords:
paravertebral blockthoracic surgery

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Area of Science:

  • Anesthesiology
  • Thoracic Surgery
  • Regional Anesthesia

Background:

  • Paravertebral blockade (PVB) involves injecting local anesthetic lateral to spinal nerves for somatosensory and sympathetic blockade.
  • PVB is a versatile technique for unilateral or bilateral anesthesia and pain management, particularly for chest and abdominal pain.
  • Historically, PVB is an almost lost technique that has seen a resurgence in recent years.

Purpose of the Study:

  • To evaluate current opinion, clinical practice, and innovations related to PVB in thoracic surgery.
  • To review the history, techniques, application, ease of placement, and safety of PVB.
  • To analyze studies from Cochrane library, Embase, and Medline (1995-2017) on PVB in thoracic surgery.

Main Methods:

  • Literature review of studies and reference lists from major databases.
  • Evaluation of existing evidence on thoracic PVB compared to thoracic epidural analgesia (TEA).
  • Analysis of factors influencing the choice between PVB and TEA.

Main Results:

  • Thoracic PVB provides post-thoracotomy pain relief comparable to TEA with fewer side effects.
  • Bilateral thoracic PVB appears feasible and practical for bilateral thoracic surgery.
  • No consensus exists on the optimal approach for thoracic PVB technique (landmark, ultrasound, or stimulation-based).

Conclusions:

  • Thoracic PVB is a non-inferior alternative to TEA for postoperative analgesia in thoracic surgery.
  • Selection of regional technique depends on side effect tolerance, consensus, and operator experience.
  • Further clinical trials are needed to investigate the efficacy of PVB versus TEA in preventing chronic post-thoracotomy pain.