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Related Concept Videos

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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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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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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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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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: 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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Anesthetic considerations for repeat cesarean section.

Alexander Ioscovich1, Yaacov Gozal, Daniel Shatalin

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Anesthetic management for repeat cesarean sections is similar to primary cesarean sections unless abnormal placentation is present. Early diagnosis and a multidisciplinary approach are vital for managing high-risk pregnancies and preventing complications.

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Area of Science:

  • Anesthesiology
  • Obstetrics
  • Maternal-Fetal Medicine

Background:

  • Cesarean delivery rates are rising globally, increasing the incidence of repeat cesarean sections.
  • A history of cesarean delivery often leads to repeat procedures, impacting anesthetic considerations.
  • Trial of Labor After Cesarean section (TOLAC) advances have not fully curbed the cesarean delivery trend.

Purpose of the Study:

  • To compare perioperative anesthetic management between repeat and primary cesarean sections.
  • To identify specific anesthetic challenges and strategies for repeat cesarean deliveries.
  • To evaluate the impact of abnormal placentation on anesthetic management in repeat cesarean sections.

Main Methods:

  • This is a review article, synthesizing existing literature on anesthetic management for cesarean sections.
  • The review focuses on comparing anesthetic protocols for primary versus repeat cesarean deliveries.
  • Key topics include risk assessment, abnormal placentation, multidisciplinary care, and management of complications.

Main Results:

  • Anesthetic management for repeat cesarean sections without abnormal placentation is largely comparable to primary cesarean sections.
  • Early diagnosis of high-risk cases, particularly abnormal placentation, is critical.
  • A multidisciplinary approach involving anesthesiologists, gynecologists, and radiologists is essential for managing complex cases.

Conclusions:

  • For repeat cesarean sections without abnormal placentation, anesthetic management mirrors that of primary procedures.
  • Timely diagnosis of abnormal placentation and a collaborative, multidisciplinary approach are crucial for preventing maternal morbidity and mortality.
  • Implementing institutional protocols and utilizing new technologies can improve outcomes in high-risk cesarean deliveries.