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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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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: Common Agents and Their Applications01:23

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride 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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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: Clinical Application as Spinal Anesthesia01:11

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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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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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...
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Operating Room Black Box Technology to Mitigate Local Anesthetic Systemic Toxicity Risk Associated With Liposomal

Gyuhyun Lee1, Barbara S Turner2, Jessica D Szydlowski2

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Journal of Perianesthesia Nursing : Official Journal of the American Society of Perianesthesia Nurses
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PubMed
Summary

Operating room black box technology improved adherence to liposomal bupivacaine (LB) protocols, reducing risks of local anesthetic systemic toxicity (LAST). This quality improvement project highlights technology

Keywords:
LASTanesthesiologyliposomal bupivacainelocal anesthetic systemic toxicityoperating room black box

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Area of Science:

  • Anesthesiology
  • Patient Safety
  • Quality Improvement

Background:

  • Local anesthetic systemic toxicity (LAST) is a rare but serious complication.
  • Liposomal bupivacaine (LB) administration requires strict adherence to protocols to prevent LAST.
  • Operating room black box (ORBB) technology offers a novel approach to monitor protocol adherence.

Purpose of the Study:

  • To evaluate the effectiveness of ORBB technology in monitoring adherence to LB administration protocols.
  • To identify obstacles to LB protocol compliance.
  • To mitigate the risk of LAST through improved adherence.

Main Methods:

  • Retrospective chart review of 39 patients receiving intraoperative LB.
  • Utilized ORBB technology and electronic medical records for data collection.
  • Focused on adherence to LB time-outs, wristband application, lidocaine infusion checks, and admixture ratios.

Main Results:

  • 64% of cases completed LB time-out; 62% applied LB wristbands.
  • 36% incorporated lidocaine infusion checks during time-outs.
  • No LAST cases were reported, though some protocol deviations occurred.

Conclusions:

  • ORBB technology shows potential for enhancing LB protocol adherence and patient safety.
  • Identified challenges include ORBB blind zones and the Hawthorne effect.
  • Recommendations include staff training, data sharing, and cross-referencing with EMRs.