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Related Concept Videos

Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

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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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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.
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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Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

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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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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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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 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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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
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Hemodynamic changes in patients undergoing office-based sinus procedures under local anesthesia.

Michael T Chang1, Kawinyarat Jitaroon2, Teresa Nguyen1

  • 1Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA.

International Forum of Allergy & Rhinology
|January 4, 2020
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Summary

Office-based endoscopic sinus procedures under local anesthesia are generally well-tolerated. However, older patients may experience significant blood pressure changes during these procedures.

Keywords:
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Area of Science:

  • Otolaryngology
  • Anesthesiology
  • Cardiovascular Physiology

Background:

  • Office-based endoscopic sinus procedures are increasingly common.
  • Local anesthesia is used for these outpatient interventions.
  • Hemodynamic, pain, and anxiety changes require characterization.

Purpose of the Study:

  • To evaluate hemodynamic, pain, and anxiety changes during office-based endoscopic sinus procedures.
  • To identify factors influencing these physiological responses.

Main Methods:

  • Prospective study of 25 adult patients undergoing office-based endoscopic sinus procedures.
  • Local anesthesia with topical lidocaine/oxymetazoline and submucosal lidocaine/epinephrine.
  • Monitoring of vital signs, pain scores, and State-Trait Anxiety Inventory (STAI) scores.

Main Results:

  • Mean maximal systolic blood pressure increase was 24.6 mmHg; heart rate increased by 22.8 bpm.
  • Older age was associated with a significant increase in systolic blood pressure (>20 mmHg).
  • Mean pain scores were low (1.5), and anxiety levels did not change significantly.

Conclusions:

  • Office-based endoscopic sinus procedures are generally well-tolerated by patients.
  • Significant blood pressure fluctuations can occur, particularly in older individuals.
  • Healthcare providers should monitor hemodynamics closely during these procedures.