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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

714
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...
714
Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

511
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...
511
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

477
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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Related Experiment Video

Updated: Aug 12, 2025

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

Published on: November 8, 2024

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The Administration of Tranexamic Acid For Complex Spine Surgery.

Kristen Jockel1, Amanda Lee2, Marianne S Cosgrove3

  • 1is a staff CRNA at Yale New Haven Hospital and a clinical preceptor for the Yale New Haven Hospital School of Nurse Anesthesia, New Haven, Connecticut.

AANA Journal
|February 1, 2023
PubMed
Summary

High-dose tranexamic acid (TXA) effectively reduces blood loss during complex spine surgery. This approach improves patient outcomes and optimizes blood product use without increasing complications.

Keywords:
antifibrinolyticscomplex spine surgeryhemorrhagetranexamic acidtransfusion

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Area of Science:

  • Orthopedic Surgery
  • Anesthesiology
  • Hematology

Background:

  • Instrumented spinal surgeries, numbering 1.62 million annually in the US, often involve significant blood loss due to complex procedures and the spine's vascularity.
  • Excessive intraoperative blood loss predicts postoperative morbidity and necessitates transfusions.
  • Antifibrinolytic medications are used to mitigate perioperative bleeding in high-risk surgeries.

Purpose of the Study:

  • To evaluate the efficacy and safety of tranexamic acid (TXA) in reducing blood loss during major or complex spine surgery.
  • To investigate the impact of different TXA dosing regimens on perioperative outcomes.
  • To address the existing ambiguity surrounding optimal TXA dosage for multilevel spine procedures.

Main Methods:

  • Review of current evidence on the use of tranexamic acid (TXA), a lysine analog that inhibits plasminogen activation.
  • Analysis of studies comparing intravenous and topical TXA administration in perioperative settings.
  • Examination of recent data comparing high-dose versus low-dose TXA regimens in spine surgery patients.

Main Results:

  • Perioperative administration of TXA (intravenous and topical) safely and effectively reduces blood loss, transfusion needs, and hospital stay in complex spine surgery.
  • Recent evidence indicates high-dose TXA significantly decreases perioperative blood loss compared to low-dose TXA.
  • No increase in perioperative morbidity or mortality was observed with high-dose TXA administration.

Conclusions:

  • Tranexamic acid is a valuable tool for managing blood loss in major and complex spine surgeries.
  • Higher doses of TXA appear more effective in reducing blood loss without compromising patient safety.
  • Implementing evidence-based high-dose TXA regimens can enhance surgical outcomes and improve blood product management.