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Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

179
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.
179
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...
477
General Anesthesia: Overview01:24

General Anesthesia: Overview

264
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...
264
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

414
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
414
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
Stages of General Anesthesia01:22

Stages of General Anesthesia

552
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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Anesthetic Considerations for Second-Trimester Surgical Abortions.

Elizabeth Ozery1, Jessica Ansari1, Simranvir Kaur2

  • 1From the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California.

Anesthesia and Analgesia
|February 2, 2023
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Summary

Anesthesiologists may see more second-trimester abortions due to access barriers. Safe anesthetic care requires considering cervical preparation, deep sedation, and potential complications like uterine atony.

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Area of Science:

  • Anesthesiology
  • Obstetrics
  • Reproductive Health

Background:

  • Most abortions occur in office settings, but 1% occur in the second trimester.
  • Regulatory changes may increase second-trimester abortions due to access barriers and travel.
  • Anesthesiologists may face increased demand for second-trimester abortion care.

Purpose of the Study:

  • To outline unique anesthetic considerations for second-trimester abortions.
  • To inform anesthesiologists about evolving practices and patient needs.

Main Methods:

  • Review of literature on anesthetic management for second-trimester abortions.
  • Discussion of cervical preparation techniques and their timing.
  • Evaluation of sedation versus intubation strategies based on gestational age.

Main Results:

  • Second-trimester abortions involve multiday cervical preparation, creating time-sensitive procedures.
  • Deep sedation without intubation may be safe and preferable through 24 weeks gestation, challenging older dogma.
  • Management requires attention to substance use disorders, pain, and uterine atony.

Conclusions:

  • Anesthesiologists need specialized knowledge for second-trimester abortion care.
  • Adapting anesthetic techniques, like deep sedation, is crucial for patient safety.
  • Addressing patient comorbidities and potential complications is essential for compassionate care.