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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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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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Hypothesis: Accept or Fail to Reject?01:17

Hypothesis: Accept or Fail to Reject?

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The outcome of any hypothesis testing leads to rejecting or not rejecting the null hypothesis. This decision is taken based on the analysis of the data, an appropriate test statistic, an appropriate confidence level, the critical values, and P-values. However, when the evidence suggests that the null hypothesis cannot be rejected, is it right to say, 'Accept' the null hypothesis?
There are two ways to indicate that the null hypothesis is not rejected. 'Accept' the null...
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General Anesthesia: Overview01:24

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.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
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Stages of General Anesthesia01:22

Stages of General Anesthesia

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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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Spinal Cord01:26

Spinal Cord

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The spinal cord, a critical component of the central nervous system, extends from the base of the brainstem to the lumbar region of the vertebral column. It is essential for maintaining physical stability and facilitating communication between the brain and peripheral parts of the body.
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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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Related Experiment Video

Updated: Jan 24, 2026

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation
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Contributors to failed spinal anesthesia.

Sitotaw Tesfa Zegeye1, Belete Muluadam Admassie1, Esubalew Muluneh Aligaz1

  • 1Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Ethiopia.

The Journal of International Medical Research
|January 23, 2026
PubMed
Summary

Failed spinal anesthesia, a common challenge in surgery, is often caused by technical issues, patient factors, and specific circumstances. Optimizing anesthetic techniques and provider training can help reduce failure rates.

Keywords:
Spinal anesthesiacontributorsfailed spinal anesthesianeuraxial blockregional anesthesia

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Area of Science:

  • Anesthesiology
  • Surgical Procedures

Background:

  • Spinal anesthesia is a widely used technique for various surgeries.
  • Failed spinal anesthesia presents challenges including patient discomfort and conversion to general anesthesia.

Purpose of the Study:

  • To systematically review contemporary evidence (2015-2025) on predictors of failed spinal anesthesia.
  • Identify key factors contributing to spinal anesthesia failure.

Main Methods:

  • Systematic literature search across major databases (PubMed, Embase, Cochrane, Web of Science, Google Scholar).
  • Inclusion of studies published between January 2015 and May 2025.
  • Methodological quality assessment using the Joanna Briggs Institute tool.

Main Results:

  • Twenty-one studies across obstetric, orthopedic, urologic, and general surgery were analyzed.
  • Failure rates varied widely, from 0.9% to 25.3%.
  • Identified predictors include low anesthetic dose, isobaric solutions, provider inexperience, bloody CSF, absent CSF flow, L4-L5 puncture, high BMI, prior spinal exposure, emergency surgery, and multiple attempts.

Conclusions:

  • Failed spinal anesthesia is multifactorial, involving technical, patient, and contextual elements.
  • Improving technique, dosing, provider training, and patient assessment can mitigate failure rates.