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Related Concept Videos

General Anesthesia: Overview01:24

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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.
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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.
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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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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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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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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Regional anesthesia considerations for cardiac surgery.

Henry Liu1, Patrick I Emelife2, Amit Prabhakar3

  • 1Department of Anesthesiology, Drexel University College of Medicine, Reading Hospital-Tower Health System, 245 N. 15th Street, Philadelphia, PA 19102, USA.

Best Practice & Research. Clinical Anaesthesiology
|December 4, 2019
PubMed
Summary

Regional anesthesia techniques, including chest wall, sternal, and neuraxial blocks, offer benefits for managing cardiac surgery pain. These methods aim to reduce opioid use and improve patient recovery after surgery.

Keywords:
anesthesiachest wallnerve blocksregional anesthesiathoracic nerves

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Area of Science:

  • Anesthesiology
  • Pain Management
  • Thoracic Surgery

Background:

  • Acute pain is a major challenge following cardiac surgery.
  • Multimodal pain management strategies are evolving with advancements in cardiac anesthesia.
  • Regional anesthesia techniques are gaining traction for perioperative pain control.

Purpose of the Study:

  • To review current regional anesthesia techniques used in cardiac surgery.
  • To summarize the indications, techniques, complications, and benefits of these regional blocks.
  • To highlight the potential advantages of regional anesthesia for enhanced recovery after cardiac surgery.

Main Methods:

  • Focus on currently employed regional techniques in cardiac surgical procedures.
  • Includes chest wall blocks (e.g., PECS I and II, SAP, ESB, PVB).
  • Includes sternal blocks (e.g., TTMPB, PSINB) and neuraxial blocks (e.g., TEA, high spinal anesthesia).

Main Results:

  • Regional techniques can effectively manage acute pain after cardiac surgery.
  • These methods contribute to reduced perioperative opioid consumption.
  • Potential for enhanced recovery after surgery (ERAS) protocols.

Conclusions:

  • Regional anesthesia techniques show promise for cardiac surgery patients.
  • Careful patient selection and well-controlled indications are crucial for successful application.
  • These evolving techniques can be valuable components of multimodal pain management strategies.