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Related Concept Videos

Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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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

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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Kidney Transplant II: Surgical Procedure01:26

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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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: 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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Related Experiment Video

Updated: Aug 23, 2025

CO2-Lasertonsillotomy Under Local Anesthesia in Adults
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Performing percutaneous nephrolithotomy under modified local anesthesia.

Yue Yu1, Jieping Hu1, Wei Liu1

  • 1Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Frontiers in Surgery
|October 28, 2022
PubMed
Summary
This summary is machine-generated.

Percutaneous nephrolithotomy (PCNL) with vacuum-assisted sheaths under modified local anesthesia is practical and effective for kidney stone removal. This minimally invasive technique shows promising results for stone clearance in patients.

Keywords:
ASA—American Society of Anesthesiologistsmodified local anesthesiapercutaneous nephrolithotomy (PCNL)physical statusrenal stone

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Nephrolithiasis Management

Background:

  • Percutaneous nephrolithotomy (PCNL) is a standard procedure for kidney stone removal.
  • Modified local anesthesia (m-LA) offers a less invasive alternative to general anesthesia.
  • Vacuum-assisted nephrostomy sheaths aim to improve safety and efficacy during PCNL.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of PCNL using vacuum-assisted nephrostomy sheaths.
  • To assess the safety and outcomes of PCNL performed under modified local anesthesia (m-LA).
  • To determine the stone-free rate and patient tolerance for this technique.

Main Methods:

  • A pilot study involving 83 patients undergoing PCNL with vacuum-assisted sheaths (18F or 20F) under m-LA.
  • Ultrasound-guided instillation of lidocaine and ropivacaine for local anesthesia.
  • Monitoring of vital signs, operative time, pain scores (VAS), hemoglobin, CRP, and stone clearance.

Main Results:

  • Successful completion of all operations with a mean operative time of 55.1 minutes.
  • Low mean visual analogue scale (VAS) score of 3.9 indicating manageable pain.
  • Overall stone-free rate of 69.9% (93.8% for simple stones, 54.9% for complex stones).

Conclusions:

  • PCNL with vacuum-assisted nephrostomy sheaths under m-LA is a practical and effective approach.
  • The technique demonstrates good tolerability and acceptable stone clearance rates.
  • Ultrasound guidance enhances the safety and precision of local anesthesia administration.