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Related Concept Videos

Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

476
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
476
Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

712
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...
712
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

445
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
445
Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers01:24

Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers

691
Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
691
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

298
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
298
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

88
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.
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Related Experiment Video

Updated: May 20, 2025

Testing the Efficacy of Pharmacological Agents in a Pericardial Target Delivery Model in the Swine
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"Optimizing" the Anesthetic for Cardiac Contractility Modulation Devices.

Samit Ghia1, Ashanay Allen2, Ranjit Suri3

  • 1Department of Anesthesiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island, NY, USA.

The Journal of Innovations in Cardiac Rhythm Management
|March 24, 2025
PubMed
Summary
This summary is machine-generated.

This case report discusses the Optimizer® Smart Implantable Pulse Generator, a cardiac contractility modulation (CCM) device. Anesthetic choices and electromagnetic interference are key considerations for CCM device implantation and function.

Keywords:
Cardiac anesthesiacardiac contractility modulationelectrophysiologyheart failure

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Biomedical Engineering

Background:

  • Cardiac contractility modulation (CCM) devices, like the Optimizer® Smart Implantable Pulse Generator, aim to improve cardiac function in heart failure patients.
  • These devices deliver non-excitatory electrical signals to the right ventricular septum during the cardiac refractory period via transvenous leads.

Observation:

  • Anesthetic administration can impact lead positioning during implantation.
  • High-dose propofol may cause diaphragmatic stimulation due to attenuated contraction and discomfort from malpositioned leads.
  • The Optimizer® device activity can cause specific electrocardiogram (ECG) findings, including upward RS segment deflections.

Findings:

  • Local or conscious sedation is recommended over general anesthesia for CCM device implantation to avoid complications related to lead positioning.
  • Strong electromagnetic fields pose a risk of disrupting the function of implanted CCM devices.

Implications:

  • Understanding anesthetic implications is crucial for successful CCM device implantation and patient management.
  • Awareness of potential device interference is necessary for patients with CCM devices, particularly in environments with electromagnetic fields.