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Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

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...

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...

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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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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.

General Anesthesia: Overview

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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.
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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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Related Experiment Video

Updated: Aug 9, 2025

Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model

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Published on: June 18, 2021

Spinal Anesthesia in Hemodynamic Instability: A Case Report.

Luciana Lopes¹, Joana Marialva¹, Helder Cardoso¹

¹Department of Anesthesia, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT.

|February 23, 2023

Summary

This summary is machine-generated.

This case report details successful spinal anesthesia for hip surgery in a hemodynamically unstable patient recovering from COVID-19 pneumonia. Continuous spinal anesthesia and norepinephrine managed risks associated with general anesthesia and airway manipulation.

Keywords:

continuous spinal anesthesia contraindication hemodynamic instability medical dilemma prophylactic norepinephrine

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Last Updated: Aug 9, 2025

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Area of Science:

Anesthesiology
Critical Care Medicine

Background:

Anesthetic management presents challenges in patients with comorbid conditions, including risks with general anesthesia and contraindications for neuraxial techniques.
The coronavirus disease 2019 (COVID-19) pandemic introduced unique anesthetic dilemmas, particularly concerning patients with recent severe respiratory illness.

Observation:

A patient with severe hemodynamic instability and recent SARS-CoV-2 pneumonia required surgical hip debridement.
General anesthesia and airway manipulation were deemed high-risk due to the patient's pulmonary status and limited availability of postoperative ventilatory support during the early pandemic.

Findings:

Continuous spinal anesthesia was successfully administered using a conventional epidural catheter.
Prophylactic norepinephrine infusion was employed to manage the patient's cardiovascular instability throughout the procedure.

Implications:

This case demonstrates the feasibility and safety of continuous spinal anesthesia in complex patients where general anesthesia is contraindicated.
The described technique offers a viable alternative for anesthetic management in patients with severe hemodynamic instability and recent respiratory infections.
Effective management strategies for high-risk surgical patients during pandemics are crucial for optimizing patient outcomes.