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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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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 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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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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Stages of General Anesthesia01:22

Stages of General Anesthesia

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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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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
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STA-MCA Bypass Under Local Anesthesia.

Yasuhiko Kaku1, Tetsuya Yamada2, Kiyomitsu Kanou2

  • 1Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan. kaku@murakami.asahi-u.ac.jp.

Acta Neurochirurgica. Supplement
|September 2, 2018
PubMed
Summary

Superficial temporal artery to middle cerebral artery (STA-MCA) bypass can be safely performed without general anesthesia in select patients. This minimally invasive approach using local anesthesia and sedation offers high patient satisfaction and successful bypass patency.

Keywords:
Local anesthesiaMinimally invasive techniqueSTA-MCA bypass

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Area of Science:

  • Neurosurgery
  • Vascular Surgery
  • Anesthesiology

Background:

  • The superficial temporal artery to middle cerebral artery (STA-MCA) bypass is an evolving procedure aimed at reducing surgical risks.
  • Performing STA-MCA bypass without endotracheal general anesthesia is a potential strategy to further simplify the procedure and minimize invasiveness.

Observation:

  • This study evaluated 45 patients undergoing STA-MCA bypass using local anesthesia with dexmedetomidine sedation and an unsecured airway.
  • Preoperative computed tomography angiography precisely identified optimal vessel proximity for a minimally invasive approach.
  • The procedure was performed between February 2010 and April 2016 for patients with cerebrovascular occlusive disease and comorbidities.

Findings:

  • All 45 patients successfully underwent STA-MCA bypass with good hemodynamic stability and no conversion to general anesthesia.
  • The bypass patency rate was 97.8% (44/45 patients) confirmed by postoperative angiography.
  • The overall complication rate was 6.3%, with no recurrence of ipsilateral cerebral ischemia during follow-up.

Implications:

  • Performing STA-MCA bypass under local anesthesia without general anesthesia is feasible.
  • This technique offers a safe and effective alternative for select patients, potentially reducing anesthetic and surgical morbidity.
  • Further research can explore expanding patient selection criteria for this less invasive approach.