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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 Intravenous Regional Anesthesia01:16

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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 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: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

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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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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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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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Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow
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Awake Fiberoptic Intubation in Cervical Spine Injury: A Comparison between Atomized Local Anesthesia versus Airway

J Singh1, S Shakya1, B Shrestha1

  • 1Department of Anesthesia, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.

Kathmandu University Medical Journal (KUMJ)
|November 16, 2019
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Summary

Nerve blocks for airway anesthesia significantly reduce intubation time and patient discomfort during awake fiberoptic intubation in cervical spine injury patients compared to atomized local anesthetic. This technique improves patient comfort and procedural efficiency.

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Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Awake fiberoptic intubation is crucial for patients with cervical spine injury, enabling pre- and post-procedure neurological assessments.
  • Managing airway anesthesia in these patients is vital to minimize discomfort and potential injury.
  • Comparing nerve blocks with topical anesthesia is essential for optimizing this procedure.

Purpose of the Study:

  • To compare the efficacy of transtracheal and bilateral superior laryngeal nerve blocks versus atomized lignocaine for airway anesthesia.
  • To evaluate differences in intubation time and patient discomfort (coughing and gagging) during awake fiberoptic intubation.
  • To determine the preferred method for airway management in cervical spine injury patients requiring awake intubation.

Main Methods:

  • A randomized study included 30 patients with cervical spine injury scheduled for awake fiberoptic intubation.
  • Patients were divided into two groups: Group N (nerve block) and Group A (atomized lignocaine).
  • Intubation time, cough, and gag scores were recorded to assess patient discomfort and procedural efficiency.

Main Results:

  • Awake fiberoptic intubation time was significantly shorter in the nerve block group (90.2±11.7s) compared to the atomizer group (210.4±10.6s) (p=0.041).
  • The nerve block group experienced significantly fewer coughing and gagging episodes (1 patient) than the atomizer group (11 patients) (p=0.006).
  • Patient comfort and ease of intubation were markedly better with nerve blocks.

Conclusions:

  • Transtracheal and bilateral superior laryngeal nerve blocks provide superior airway anesthesia for awake fiberoptic intubation in patients with potential difficult airways.
  • This nerve block technique leads to reduced patient discomfort and faster intubation times.
  • Nerve blocks are recommended over topical anesthesia with atomizers for improved outcomes in this patient population.