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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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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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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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Stages of General Anesthesia01:22

Stages of General Anesthesia

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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Endoscopic Studies II: Thoracocentesis01:26

Endoscopic Studies II: Thoracocentesis

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Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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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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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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Local Anesthesia Thoracoscopy with versus without Midazolam: A Randomized Controlled Trial.

Andreas Koulelidis1, Stavros Anevlavis1, Nikolaos Nikitidis2

  • 1Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.

Respiration; International Review of Thoracic Diseases
|November 18, 2020
PubMed
Summary

Midazolam combined with lidocaine for local anesthetic thoracoscopy (LAT) does not increase respiratory side effects. This combination significantly improves patient quality of life, making it a preferred strategy.

Keywords:
AnesthesiaLidocaineMidazolamPleural diseasePleural effusionPleuroscopyRandomized studyThoracoscopy

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Area of Science:

  • Pulmonology
  • Anesthesiology
  • Thoracic Surgery

Background:

  • Medical thoracoscopy is the standard for diagnosing pleural diseases.
  • Current guidelines lack consensus on sedative/analgesic choices for local anesthetic thoracoscopy (LAT).
  • Concerns exist regarding potential respiratory side effects of sedatives during LAT.

Purpose of the Study:

  • To evaluate if midazolam, when administered with lidocaine for LAT, increases respiratory side effects compared to lidocaine alone.
  • To assess the impact of midazolam on patient quality of life during LAT.

Main Methods:

  • A randomized study assigned 80 patients undergoing LAT into two groups: lidocaine alone (n=40) or lidocaine with midazolam (n=40).
  • The primary endpoint was the mean lowest oxygen saturation.
  • Secondary endpoints included cardiovascular parameters, complications, drainage duration, hospital stay, and quality of life (QoL) via visual analog scale (VAS).

Main Results:

  • No significant difference in oxygen saturation was observed between the lidocaine-only and lidocaine-midazolam groups.
  • The group receiving midazolam with lidocaine reported significantly improved quality of life (QoL) as measured by VAS.
  • Demographics and cardiovascular parameters showed no significant differences between the groups.

Conclusions:

  • Midazolam does not exacerbate respiratory side effects when used with lidocaine for LAT.
  • Combining midazolam with lidocaine for LAT improves patient quality of life.
  • This combination is now the preferred strategy in the study department.