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Related Concept Videos

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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National Nursing Organizations II01:30

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Nursing organizations play a vital role in representing nurses working in specialized clinical settings, such as the American Association of Critical-Care Nurses (AACN).
The AACN emphasizes a healthy work environment through six standards to achieve an optimal patient outcome. The standards are appropriate staffing, meaningful recognition, collaboration, authentic leadership, effective communication, and decision-making. In addition, AACN provides certification programs, webinars, journals, and...
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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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Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

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Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
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Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

837
Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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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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Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition
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NOACs in Anesthesiology.

Donat R Spahn1, Jürg-Hans Beer2, Alain Borgeat3

  • 1Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.

Transfusion Medicine and Hemotherapy : Offizielles Organ Der Deutschen Gesellschaft Fur Transfusionsmedizin Und Immunhamatologie
|November 9, 2019
PubMed
Summary
This summary is machine-generated.

For patients on new oral anticoagulants (NOACs), discontinue the medication 24-36 hours before elective surgery, adjusting for kidney function. Manage emergencies based on NOAC plasma levels and consider reversal agents for bleeding risks.

Keywords:
AnesthesiologyDirect oral anticoagulantsNew oral anticoagulantsThrombin inhibitorXa antagonist

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Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Cardiology

Background:

  • Increasing use of new oral anticoagulants (NOACs) presents frequent clinical challenges.
  • Clinicians require guidance for managing NOACs in various patient scenarios.

Purpose of the Study:

  • To provide practical recommendations for perioperative management of NOACs.
  • To offer guidance on handling NOAC overdoses and bleeding events.

Main Methods:

  • Literature review and expert consensus on NOAC management.
  • Analysis of drug discontinuation timing based on surgery type and renal function.
  • Guidelines for managing NOACs in emergency situations and bleeding.

Main Results:

  • Discontinue NOACs 24-36 hours before elective surgery (longer for impaired renal function).
  • Emergency management depends on NOAC plasma levels (≤30 ng/ml permits surgery; >30 ng/ml may require reversal agents).
  • Restart NOACs 24 hours after low-risk surgery, or 48-72 hours after high-risk surgery.

Conclusions:

  • NOAC management requires careful timing of discontinuation and re-initiation around surgical procedures.
  • Plasma levels are crucial for managing emergency interventions and bleeding risks associated with NOACs.
  • Reversal agents are indicated for significant bleeding or high NOAC levels in emergency settings.