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Related Concept Videos

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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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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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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Local Anesthetics: Pharmacokinetics01:13

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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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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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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
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Fewer Wrong-Site Peripheral Nerve Blocks Following Updates to Anesthesia Time-Out Policy.

Stephen N Harris1, Sarah C Ortolan1, Chris R Edmonds1

  • 1Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA.

HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery
|August 23, 2021
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Summary

Implementing a team-focused time-out process significantly reduced wrong-site blocks (WSBs) during peripheral nerve blocks (PNBs). This enhanced safety protocol led to a substantial decrease in WSB incidence, improving patient care.

Keywords:
risk reductionteam dynamicstime-outwrong-site block

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Area of Science:

  • Anesthesiology
  • Patient Safety
  • Surgical Risk Mitigation

Background:

  • Peripheral nerve blocks (PNBs) are increasingly used but carry risks, including wrong-site blocks (WSBs).
  • A 2003 policy mandated a time-out, with further enhancements in 2007 involving nurse-led needle access and bedside presence.
  • These policy changes aimed to mitigate the risk of WSBs during PNB procedures.

Purpose of the Study:

  • To compare the incidence of WSBs before and after the implementation of an enhanced time-out process for PNBs.
  • To determine if the enhanced safety protocol effectively reduced WSB rates.

Main Methods:

  • Retrospective analysis of quality assurance data from January 2003 to December 2016.
  • Comparison of WSB incidence rates pre- and post-policy changes using relative risks and Fisher's exact tests.
  • Inclusion of data on upper extremity, lower extremity, and all PNBs, with root cause analyses for reported WSBs.

Main Results:

  • The incidence of WSBs decreased from 1.10 per 10,000 blocks before policy changes to 0.24 per 10,000 blocks afterward.
  • A statistically significant reduction in WSB incidence was observed following the enhanced time-out implementation.

Conclusions:

  • An association exists between a dynamic, team-focused time-out process and a reduction in WSBs during PNBs.
  • While the enhanced time-out appears effective, a causal link cannot be definitively established due to study design limitations.
  • Further research is warranted to confirm causality and explore confounding factors in WSB reduction strategies.