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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

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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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According to obedience research, we may harm others under the forceful pressures of an authority figure (Milgram, 1974). How about if the inappropriate orders were delivered with less force? The increasing interdependence between nurses and physicians compelled Hofling and his colleagues to explore nurses’ reactions to a potentially harmful medical request made by the perceived authority figure, the doctor (Hofling, Brotzman, Dalrymple, Graves, & Pierce, 1966). In this situation,...
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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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Analgesia and Pain Management01:25

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

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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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Related Experiment Video

Updated: Dec 21, 2025

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Parents Demand and Teenager Refuses Epidural Anesthesia.

Ivor Berkowitz1, Alyssa Burgart2, Robert D Truog3

  • 1Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.

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Summary

A pediatric patient refused an epidural for pain management due to fear of paralysis. Experts debate whether to honor the patient's wishes or proceed with the recommended epidural for optimal pain relief.

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Area of Science:

  • Pediatric Anesthesiology
  • Oncology
  • Bioethics

Background:

  • A 15-year-old patient with metastatic Ewing sarcoma requires an upper lobectomy.
  • Postoperative analgesia with a thoracic epidural catheter was recommended.
  • The patient expressed significant fear and opposition to the epidural procedure due to needle phobia and fear of paralysis.

Observation:

  • The patient remained vehemently opposed to the epidural despite reassurance of comfort during the procedure.
  • Parents requested the epidural be placed after the patient was sedated, believing it was in her best interest for optimal pain management.
  • This presents an ethical dilemma regarding patient autonomy versus parental/physician recommendations.

Findings:

  • The case highlights the conflict between a minor patient's expressed wishes and the recommended medical intervention for pain control.
  • It raises questions about informed consent, patient autonomy, and the role of parental authority in pediatric care.
  • Expert discussion is needed to weigh the benefits of effective analgesia against the psychological distress and ethical considerations of overriding patient refusal.

Implications:

  • This scenario underscores the importance of addressing patient fears and involving them in decision-making, even when they are minors.
  • It necessitates careful consideration of alternative pain management strategies when a recommended procedure is refused.
  • Ethical guidelines and communication strategies are crucial for navigating such complex patient-physician-parent dynamics in pediatric oncology.