Caudal anesthesia involves needle penetration through the sacral hiatus into the sacral canal. In adults, the sacrum is a triangular bone formed from the fusion of five sacral vertebrae. It differs in neonates and infants due to delayed myelination and fusion of vertebrae. The sacral hiatus is wider in children, allowing easier identification and catheter insertion for caudal anesthesia. Regional techniques require lower approaches in pediatrics due to the lower termination of the spinal cord and dural sac.
Spinal anaesthesia involves injecting local anaesthetic into the cerebrospinal fluid surrounding the spinal cord. A brief history was provided including the discovery of cerebrospinal fluid in the 1700s and the first planned spinal anaesthesia on a human in 1891. Key anatomy was discussed including the levels of the spinal cord and vertebrae. Common local anaesthetics used for spinal anaesthesia like bupivacaine and ropivacaine were listed along with typical dosages. Factors affecting the level of spinal block were summarized.
This document provides information on spinal anaesthesia. It discusses the history of spinal anaesthesia, indications, contraindications, anatomy, procedure, positions, techniques, drugs used, mechanism of action, adjuvants, and factors affecting block height. The key points are:
- Spinal anaesthesia involves injecting local anaesthetic into the subarachnoid space to block nerve impulses and provide anaesthesia or analgesia.
- Common indications include surgeries of the lower body and patients with medical comorbidities. Contraindications include infection, coagulopathies, and increased intracranial pressure.
- Proper patient positioning, sterile technique, identification of spinal landmarks, and slow injection
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
Propofol is a commonly used intravenous anesthetic with the following properties:
- It acts by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and hypnosis.
- It has a rapid onset and context-sensitive half-life, distributing quickly throughout the body before being metabolized in the liver.
- It can be used for induction and maintenance of general anesthesia, as well as for sedation in the ICU. Common side effects include hypotension, respiratory depression, and pain at the injection site. Rare but serious complications include propofol infusion syndrome.
This document discusses perioperative fluid therapy. It covers topics such as total body water, fluid compartments, preoperative fluid status evaluation, intravenous fluids including crystalloids like normal saline and lactated ringer's solution and colloids like albumin, gelatin and hydroxyethyl starches. It provides guidelines on calculating fluid requirements including maintenance fluids, deficits, third spacing losses and blood loss replacement. The document emphasizes using crystalloids over colloids for resuscitation and limiting colloid volumes due to lack of evidence for their continued use in acute illness.
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
The document provides information on the management of intra-operative bronchospasm, including risk factors, triggers, diagnosis, prevention, and treatment approaches. Bronchospasm can be caused by airway irritation or anaphylaxis and presents with signs of wheezing, increased airway pressures, and falling oxygen saturation. Differential diagnoses must be ruled out. Management involves deepening anesthesia, administering bronchodilators, optimizing ventilation, and considering anaphylaxis or postponing surgery. A case example demonstrates treatment of bronchospasm potentially caused by succinylcholine-induced anaphylaxis.
Caudal anesthesia involves needle penetration through the sacral hiatus into the sacral canal. In adults, the sacrum is a triangular bone formed from the fusion of five sacral vertebrae. It differs in neonates and infants due to delayed myelination and fusion of vertebrae. The sacral hiatus is wider in children, allowing easier identification and catheter insertion for caudal anesthesia. Regional techniques require lower approaches in pediatrics due to the lower termination of the spinal cord and dural sac.
Spinal anaesthesia involves injecting local anaesthetic into the cerebrospinal fluid surrounding the spinal cord. A brief history was provided including the discovery of cerebrospinal fluid in the 1700s and the first planned spinal anaesthesia on a human in 1891. Key anatomy was discussed including the levels of the spinal cord and vertebrae. Common local anaesthetics used for spinal anaesthesia like bupivacaine and ropivacaine were listed along with typical dosages. Factors affecting the level of spinal block were summarized.
This document provides information on spinal anaesthesia. It discusses the history of spinal anaesthesia, indications, contraindications, anatomy, procedure, positions, techniques, drugs used, mechanism of action, adjuvants, and factors affecting block height. The key points are:
- Spinal anaesthesia involves injecting local anaesthetic into the subarachnoid space to block nerve impulses and provide anaesthesia or analgesia.
- Common indications include surgeries of the lower body and patients with medical comorbidities. Contraindications include infection, coagulopathies, and increased intracranial pressure.
- Proper patient positioning, sterile technique, identification of spinal landmarks, and slow injection
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
Propofol is a commonly used intravenous anesthetic with the following properties:
- It acts by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and hypnosis.
- It has a rapid onset and context-sensitive half-life, distributing quickly throughout the body before being metabolized in the liver.
- It can be used for induction and maintenance of general anesthesia, as well as for sedation in the ICU. Common side effects include hypotension, respiratory depression, and pain at the injection site. Rare but serious complications include propofol infusion syndrome.
This document discusses perioperative fluid therapy. It covers topics such as total body water, fluid compartments, preoperative fluid status evaluation, intravenous fluids including crystalloids like normal saline and lactated ringer's solution and colloids like albumin, gelatin and hydroxyethyl starches. It provides guidelines on calculating fluid requirements including maintenance fluids, deficits, third spacing losses and blood loss replacement. The document emphasizes using crystalloids over colloids for resuscitation and limiting colloid volumes due to lack of evidence for their continued use in acute illness.
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
The document provides information on the management of intra-operative bronchospasm, including risk factors, triggers, diagnosis, prevention, and treatment approaches. Bronchospasm can be caused by airway irritation or anaphylaxis and presents with signs of wheezing, increased airway pressures, and falling oxygen saturation. Differential diagnoses must be ruled out. Management involves deepening anesthesia, administering bronchodilators, optimizing ventilation, and considering anaphylaxis or postponing surgery. A case example demonstrates treatment of bronchospasm potentially caused by succinylcholine-induced anaphylaxis.
COMPLICATIONS OF SPINAL & EPIDURAL ANAESTHESIAhanisahwarrior
This document discusses complications that can occur with spinal and epidural anesthesia. It lists several common complications including hypotension, bradycardia, respiratory paralysis, nausea and vomiting, cardiac arrest, high or total spinal blocks, bloody taps, urinary retention, post-dural puncture headaches, meningitis, and cauda equina syndrome. It also discusses complications specific to epidural anesthesia such as inadequate or patchy blocks, total spinal blocks from accidental dural puncture, and dural puncture. Treatment approaches are provided for many of the complications.
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
This document discusses strategies for optimizing preoxygenation prior to endotracheal intubation. It notes that conventional preoxygenation techniques provide safe intubation for most ED patients but that a subset may still desaturate. To safely intubate this higher risk group, the document recommends optimizing preoxygenation through techniques like non-invasive ventilation, apneic oxygenation through nasal cannula, positioning patients in a head-up position, and breaking the sequence of rapid sequence intubation administration. The goal is to prevent deoxygenation and extend the safe apneic period for patients undergoing endotracheal intubation.
This document discusses spinal anatomy and physiology relevant to spinal anaesthesia. It describes the:
1. Vertebral anatomy including the 7 cervical, 12 thoracic, and 5 lumbar vertebrae. It outlines the parts of each vertebra including the body, pedicles, lamina, processes and foramina.
2. Ligaments that stabilize the vertebrae including the supraspinous, interspinous, and ligamentum flavum.
3. Meninges covering the spinal cord including the dura, arachnoid, and pia mater.
4. Spinal spaces such as the subarachnoid space containing cerebrospinal fluid, the epid
This document discusses premedication before anesthesia. It defines premedication as the administration of drugs before anesthesia induction. The goals of premedication are to provide anxiolysis, analgesia, amnesia and facilitate induction and recovery from anesthesia. Common drugs used for premedication include benzodiazepines for anxiolysis and sedation, opioids for analgesia, anticholinergics to reduce saliva production, antihistamines for their anticholinergic effects, and antiemetics to prevent nausea and vomiting. Factors like a patient's medical history, surgery type and timing must be considered when determining appropriate premedication.
Tourniquets are used in surgery to reduce blood loss by restricting blood flow to the limb. They were introduced in the 1700s and modern pneumatic tourniquets were developed in the early 1900s. Tourniquets can cause nerve injury, muscle damage, and systemic effects if not used properly. The duration of inflation should be limited to 90 minutes to prevent complications. Precise pressure and monitoring are needed to safely use tourniquets.
Anesthesia in Transurethral resection of prostateAshish Dhandare
1) The document discusses preoperative considerations and risks for anesthesia in transurethral resection of the prostate (TURP), with a focus on risks in elderly patients.
2) It provides details on TURP syndrome, a cluster of symptoms caused by absorption of irrigating fluid during surgery, and treatments for TURP syndrome and its complications like glycine toxicity, hemolysis, hypothermia, and bleeding.
3) Factors that can minimize risks of TURP syndrome are limiting surgery duration to under 1 hour, maintaining fluid bag height below 60cm, frequent bladder drainage, and careful surgical technique to preserve prostatic capsule integrity. Spinal anesthesia is recommended for its benefits in T
(1) Postoperative nausea and vomiting (PONV) is a common complication following anesthesia and surgery, with incidence rates of 22-38% for nausea and 12-26% for vomiting. (2) The vomiting center located in the brainstem plays a key role in coordinating the vomiting reflex in response to various emetogenic stimuli. (3) Identifying patient, anesthesia, and surgery risk factors can help determine those at higher risk of PONV and guide prophylaxis.
This document provides information about total intravenous anesthesia (TIVA). It begins with a definition of TIVA as a technique of general anesthesia that uses intravenous agents exclusively without inhalational gases.
It then discusses the history of TIVA, types of TIVA, indications, advantages, disadvantages, common drugs used and their properties, drug combinations, and methods of administration including single syringe, manually controlled infusion, target controlled infusion, and closed loop systems. Specific TIVA protocols, dosages, and drug mixtures are also outlined. The document aims to provide an overview of TIVA for educational purposes.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
This document provides background information and details on the technique of performing a transversus abdominis plane (TAP) block. It begins with an overview of the TAP block, including its original description and subsequent modifications using ultrasound guidance. Next, it discusses the indications for TAP blocks, including postoperative analgesia for various abdominal surgeries. The anatomy section describes the layers and nerves of the abdominal wall targeted by the block. Finally, the technique section outlines the materials, patient positioning, ultrasound probe placement, needle insertion, and local anesthetic injection steps to perform a TAP block.
This document discusses preoperative airway assessment. It begins by defining the airway and why assessing it is important, as respiratory events are a leading cause of anesthesia-related injuries. It then defines what constitutes a difficult airway and lists various individual predictors and scoring systems that can be used for assessment, including measurements of neck and mouth structures. Overall, thorough preoperative airway examination involving multiple predictive tests can help identify patients that may present difficulties during ventilation or intubation.
1) Lower limb nerve blocks provide post-operative pain relief and are safer than complete sympathectomy, though they are technically more difficult than upper limb blocks or central neuraxial blocks.
2) The lumbar and sacral plexuses give rise to various nerves that can be blocked individually or as combinations to anesthetize the lower limb, including the femoral, lateral femoral cutaneous, and obturator nerves.
3) The 3-in-1 block anesthetizes the femoral, obturator, and lateral femoral cutaneous nerves via a single injection into the femoral sheath above the inguinal ligament.
Dr. Milan Kharel presented on inhalational anesthetic agents. He discussed the history of anesthesia including the first agents used like ether and chloroform. He then covered the basic concepts of MAC, vapor pressure, factors affecting uptake and distribution of gases. The ideal characteristics of an anesthetic were noted. Various agents were classified and discussed in detail including nitrous oxide, halothane, enflurane, isoflurane, sevoflurane and desflurane.
The tumescent liposuction procedure involves the use of lidocaine (a local anesthetic), epinephrine (a hormone and a neurotransmitter that shrinks blood vessels and minimizes bleeding), and a saline solution that is injected into the treatment area. The fluid causes the fat and skin to swell up, making it easier to suction out excess fatty cells.
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
1. The technique involves preparing equipment and positioning the patient before inserting the spinal needle between vertebrae to inject local anesthetic and induce nerve block.
2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
3. Indications are for lower body and lower abdominal surgeries, with contraindications including infection, coagulopathies, and anatomical abnormalities that prevent safe needle placement.
The document discusses the history and use of laryngeal mask airways (LMA). It describes how Dr. Brain developed the first LMA prototype in 1981 as a supraglottic device that sits outside the trachea but provides an airway. Over time, different types of LMAs were developed including the classic LMA, ProSeal LMA, reinforced LMA, LMA-Unique, and Supreme LMA. The document outlines the features and proper insertion technique for each LMA and discusses their advantages, such as being less invasive than endotracheal tubes, as well as potential complications if not properly placed.
This document provides information on spinal anesthesia techniques. It begins with a brief history of spinal anesthesia dating back to 1885. It then covers topics such as indications, contraindications, preoperative evaluation, techniques, complications and their management. Specific details are provided on patient positioning, identifying anatomical landmarks, different needle approaches, administering anesthetic solutions and factors affecting spinal block height. The document aims to guide practitioners on safe and effective spinal anesthesia procedures.
This document discusses different types of breathing circuits used in anesthesia. It begins by introducing open, semi-closed, and closed breathing circuits. Open circuits are now obsolete and involved pouring anesthetic agents over a mask. Semi-closed circuits include Mapelson circuits A-F, with Type D (Bain) most commonly used for controlled ventilation. Closed circuits involve rebreathing of exhaled gases after carbon dioxide absorption by soda lime, making them very economical. Key components and properties of soda lime and factors affecting its carbon dioxide absorption are described.
Epidural anesthesia blocks pain in a specific region of the body by administering local anesthetics into the epidural space surrounding the spinal cord. This results in decreased sensation in the lower half of the body. Epidural anesthesia can be performed at different spinal levels and provides pain relief rather than total lack of sensation. It allows for selective nerve blockade and is commonly used for operations below the diaphragm when general anesthesia is contraindicated or for post-operative pain relief.
This document provides an overview of regional anesthesia techniques including spinal anesthesia, epidural anesthesia, and Bier block. Spinal anesthesia involves injecting local anesthetic into the subarachnoid space, while epidural anesthesia involves injection into the epidural space. Bier block, also called intravenous regional anesthesia, involves exsanguinating a limb and injecting local anesthetic near the tourniquet. The document describes anatomy, procedures, indications, advantages, complications, and pharmacology for each technique.
COMPLICATIONS OF SPINAL & EPIDURAL ANAESTHESIAhanisahwarrior
This document discusses complications that can occur with spinal and epidural anesthesia. It lists several common complications including hypotension, bradycardia, respiratory paralysis, nausea and vomiting, cardiac arrest, high or total spinal blocks, bloody taps, urinary retention, post-dural puncture headaches, meningitis, and cauda equina syndrome. It also discusses complications specific to epidural anesthesia such as inadequate or patchy blocks, total spinal blocks from accidental dural puncture, and dural puncture. Treatment approaches are provided for many of the complications.
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
This document discusses strategies for optimizing preoxygenation prior to endotracheal intubation. It notes that conventional preoxygenation techniques provide safe intubation for most ED patients but that a subset may still desaturate. To safely intubate this higher risk group, the document recommends optimizing preoxygenation through techniques like non-invasive ventilation, apneic oxygenation through nasal cannula, positioning patients in a head-up position, and breaking the sequence of rapid sequence intubation administration. The goal is to prevent deoxygenation and extend the safe apneic period for patients undergoing endotracheal intubation.
This document discusses spinal anatomy and physiology relevant to spinal anaesthesia. It describes the:
1. Vertebral anatomy including the 7 cervical, 12 thoracic, and 5 lumbar vertebrae. It outlines the parts of each vertebra including the body, pedicles, lamina, processes and foramina.
2. Ligaments that stabilize the vertebrae including the supraspinous, interspinous, and ligamentum flavum.
3. Meninges covering the spinal cord including the dura, arachnoid, and pia mater.
4. Spinal spaces such as the subarachnoid space containing cerebrospinal fluid, the epid
This document discusses premedication before anesthesia. It defines premedication as the administration of drugs before anesthesia induction. The goals of premedication are to provide anxiolysis, analgesia, amnesia and facilitate induction and recovery from anesthesia. Common drugs used for premedication include benzodiazepines for anxiolysis and sedation, opioids for analgesia, anticholinergics to reduce saliva production, antihistamines for their anticholinergic effects, and antiemetics to prevent nausea and vomiting. Factors like a patient's medical history, surgery type and timing must be considered when determining appropriate premedication.
Tourniquets are used in surgery to reduce blood loss by restricting blood flow to the limb. They were introduced in the 1700s and modern pneumatic tourniquets were developed in the early 1900s. Tourniquets can cause nerve injury, muscle damage, and systemic effects if not used properly. The duration of inflation should be limited to 90 minutes to prevent complications. Precise pressure and monitoring are needed to safely use tourniquets.
Anesthesia in Transurethral resection of prostateAshish Dhandare
1) The document discusses preoperative considerations and risks for anesthesia in transurethral resection of the prostate (TURP), with a focus on risks in elderly patients.
2) It provides details on TURP syndrome, a cluster of symptoms caused by absorption of irrigating fluid during surgery, and treatments for TURP syndrome and its complications like glycine toxicity, hemolysis, hypothermia, and bleeding.
3) Factors that can minimize risks of TURP syndrome are limiting surgery duration to under 1 hour, maintaining fluid bag height below 60cm, frequent bladder drainage, and careful surgical technique to preserve prostatic capsule integrity. Spinal anesthesia is recommended for its benefits in T
(1) Postoperative nausea and vomiting (PONV) is a common complication following anesthesia and surgery, with incidence rates of 22-38% for nausea and 12-26% for vomiting. (2) The vomiting center located in the brainstem plays a key role in coordinating the vomiting reflex in response to various emetogenic stimuli. (3) Identifying patient, anesthesia, and surgery risk factors can help determine those at higher risk of PONV and guide prophylaxis.
This document provides information about total intravenous anesthesia (TIVA). It begins with a definition of TIVA as a technique of general anesthesia that uses intravenous agents exclusively without inhalational gases.
It then discusses the history of TIVA, types of TIVA, indications, advantages, disadvantages, common drugs used and their properties, drug combinations, and methods of administration including single syringe, manually controlled infusion, target controlled infusion, and closed loop systems. Specific TIVA protocols, dosages, and drug mixtures are also outlined. The document aims to provide an overview of TIVA for educational purposes.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
This document provides background information and details on the technique of performing a transversus abdominis plane (TAP) block. It begins with an overview of the TAP block, including its original description and subsequent modifications using ultrasound guidance. Next, it discusses the indications for TAP blocks, including postoperative analgesia for various abdominal surgeries. The anatomy section describes the layers and nerves of the abdominal wall targeted by the block. Finally, the technique section outlines the materials, patient positioning, ultrasound probe placement, needle insertion, and local anesthetic injection steps to perform a TAP block.
This document discusses preoperative airway assessment. It begins by defining the airway and why assessing it is important, as respiratory events are a leading cause of anesthesia-related injuries. It then defines what constitutes a difficult airway and lists various individual predictors and scoring systems that can be used for assessment, including measurements of neck and mouth structures. Overall, thorough preoperative airway examination involving multiple predictive tests can help identify patients that may present difficulties during ventilation or intubation.
1) Lower limb nerve blocks provide post-operative pain relief and are safer than complete sympathectomy, though they are technically more difficult than upper limb blocks or central neuraxial blocks.
2) The lumbar and sacral plexuses give rise to various nerves that can be blocked individually or as combinations to anesthetize the lower limb, including the femoral, lateral femoral cutaneous, and obturator nerves.
3) The 3-in-1 block anesthetizes the femoral, obturator, and lateral femoral cutaneous nerves via a single injection into the femoral sheath above the inguinal ligament.
Dr. Milan Kharel presented on inhalational anesthetic agents. He discussed the history of anesthesia including the first agents used like ether and chloroform. He then covered the basic concepts of MAC, vapor pressure, factors affecting uptake and distribution of gases. The ideal characteristics of an anesthetic were noted. Various agents were classified and discussed in detail including nitrous oxide, halothane, enflurane, isoflurane, sevoflurane and desflurane.
The tumescent liposuction procedure involves the use of lidocaine (a local anesthetic), epinephrine (a hormone and a neurotransmitter that shrinks blood vessels and minimizes bleeding), and a saline solution that is injected into the treatment area. The fluid causes the fat and skin to swell up, making it easier to suction out excess fatty cells.
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
1. The technique involves preparing equipment and positioning the patient before inserting the spinal needle between vertebrae to inject local anesthetic and induce nerve block.
2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
3. Indications are for lower body and lower abdominal surgeries, with contraindications including infection, coagulopathies, and anatomical abnormalities that prevent safe needle placement.
The document discusses the history and use of laryngeal mask airways (LMA). It describes how Dr. Brain developed the first LMA prototype in 1981 as a supraglottic device that sits outside the trachea but provides an airway. Over time, different types of LMAs were developed including the classic LMA, ProSeal LMA, reinforced LMA, LMA-Unique, and Supreme LMA. The document outlines the features and proper insertion technique for each LMA and discusses their advantages, such as being less invasive than endotracheal tubes, as well as potential complications if not properly placed.
This document provides information on spinal anesthesia techniques. It begins with a brief history of spinal anesthesia dating back to 1885. It then covers topics such as indications, contraindications, preoperative evaluation, techniques, complications and their management. Specific details are provided on patient positioning, identifying anatomical landmarks, different needle approaches, administering anesthetic solutions and factors affecting spinal block height. The document aims to guide practitioners on safe and effective spinal anesthesia procedures.
This document discusses different types of breathing circuits used in anesthesia. It begins by introducing open, semi-closed, and closed breathing circuits. Open circuits are now obsolete and involved pouring anesthetic agents over a mask. Semi-closed circuits include Mapelson circuits A-F, with Type D (Bain) most commonly used for controlled ventilation. Closed circuits involve rebreathing of exhaled gases after carbon dioxide absorption by soda lime, making them very economical. Key components and properties of soda lime and factors affecting its carbon dioxide absorption are described.
Epidural anesthesia blocks pain in a specific region of the body by administering local anesthetics into the epidural space surrounding the spinal cord. This results in decreased sensation in the lower half of the body. Epidural anesthesia can be performed at different spinal levels and provides pain relief rather than total lack of sensation. It allows for selective nerve blockade and is commonly used for operations below the diaphragm when general anesthesia is contraindicated or for post-operative pain relief.
This document provides an overview of regional anesthesia techniques including spinal anesthesia, epidural anesthesia, and Bier block. Spinal anesthesia involves injecting local anesthetic into the subarachnoid space, while epidural anesthesia involves injection into the epidural space. Bier block, also called intravenous regional anesthesia, involves exsanguinating a limb and injecting local anesthetic near the tourniquet. The document describes anatomy, procedures, indications, advantages, complications, and pharmacology for each technique.
Regional anesthesia is a technique that induces loss of sensation in part of the body using local anesthetics. It has benefits like lower costs, high patient satisfaction, and decreased risks of DVT and PE compared to general anesthesia. However, it requires skills and may cause issues like hypotension. The main types are topical, intravenous, peripheral nerve blocks, plexus blocks, and neuro-axial blocks. Regional anesthesia can provide anesthesia for surgery, post-op analgesia, or chronic pain treatment. Factors like the anesthetic used, patient position, and injection speed affect its spread. Spinal and epidural blocks involve injecting anesthetic into the subarachnoid or epidural space and have risks like anaphyl
The document discusses the history and current use of spinal, epidural, and caudal anesthesia. It provides details on:
1) The key developments in these techniques from 1885 to present day and their current role in veterinary and human anesthesia.
2) The indications, contraindications, and complications of these regional anesthesia techniques.
3) The local anesthetics, opioids, and other agents used and their mechanisms of action, dosages, durations, and side effects.
4) Techniques for administering spinal, epidural, and caudal anesthesia including needle selection, injection procedures, and postoperative care.
The document provides information on performing Bier's block and fascia iliaca compartment block (FICB). It discusses the anatomy, equipment, approach, local anesthetics, and key teaching points for each procedure. Bier's block involves injecting local anesthetic intravenously to anesthetize nerves around blood vessels in the upper extremity. FICB involves injecting local anesthetic into the fascia iliaca compartment to anesthetize the femoral and lateral femoral cutaneous nerves of the thigh. Ultrasound guidance improves the success and safety of FICB compared to the landmark-based technique for Bier's block.
Regional anesthesia can be divided into neuraxial blocks and peripheral nerve blocks. Neuraxial blocks include subarachnoid, epidural and caudal anesthesia. Neuraxial blocks have specific anatomy, indications, contraindications, safety precautions, equipment, and techniques that must be followed. The document outlines the key anatomical structures involved in neuraxial blocks, when they are indicated, potential risks, how to prepare the patient, types of needles used, and proper positioning and aseptic techniques.
Peripheral nerve blocks are gaining popularity for pain management due to advantages like less nausea, hemodynamic stability, and ability to perform surgery in patients with cardiovascular or bleeding risks. Specific nerve blocks include interscalene, supraclavicular, infraclavicular, axillary, and others. Ultrasound is often used to identify nerves and nearby structures before injection of local anesthetic, allowing effective pain relief with fewer side effects compared to general or epidural anesthesia. Proper technique and understanding of anatomy are required to perform safe and effective peripheral nerve blocks.
A primer on lower extremity regional anesthesia, including instructions for sciatic, parasacral, lumbar plexus, femoral, saphenous, popliteal, lateral femoral cutaneous, obturator, and ankle blocks
Local anesthetics work by blocking sodium channels in nerves, limiting the propagation of action potentials and producing loss of sensation in a specific area. Early local anesthetics like cocaine and procaine had limitations. Lidocaine, introduced in 1940, was a major improvement as an amide-type local anesthetic with quick onset, duration of hours, and less allergenicity. Factors like lipid solubility, pH, vasoconstrictors, and dosage levels affect the onset and duration of local anesthetics. Regional anesthesia techniques involve anesthetizing broader areas using techniques like topical, field block, and peripheral or central nerve blocks.
Anatomy for Emergency Medicine. The anatomical basis of the femoral nerve and fascia iliaca blocks for femoral neck fractures. Video and notes here http://anatomyforemergencymedicine.wordpress.com/?p=136
This document discusses common adjuncts and additives used with local anesthetics for nerve blocks and spinal anesthesia. It describes how epinephrine prolongs the duration and intensity of nerve blocks by causing vasoconstriction. Alkalinization can increase the effectiveness of local anesthetics but risks of precipitation limit its usefulness. Opioids and alpha-2 adrenergic agonists provide analgesic effects when added to local anesthetics by binding to receptors in the spinal cord. Fentanyl and morphine are commonly used opioid adjuncts. Dexamethasone may also prolong the duration of local anesthetic nerve blocks when used, though the mechanism is unknown.
Conduct Of Local Anesthesia Technique And ComplicationHusni Ajaj
This document discusses regional anesthesia techniques and their complications. It covers the advantages of regional anesthesia, how local anesthetics work, different types of regional blocks including spinal, epidural, brachial plexus and others. It describes the physiology of neuroaxial blocks and their effects. Complications of various blocks like hypotension, post dural puncture headache are explained. Contraindications and techniques for specific blocks are also outlined.
Local anesthetics work by blocking nerve conduction, specifically the entry of sodium ions through voltage-gated channels. This prevents the initiation and propagation of nerve impulses in the area of administration. Local anesthetics can be classified based on their linkage as esters or amides. Amides such as lidocaine are preferred due to lower risk of allergic reactions. Techniques of local anesthesia include infiltration, nerve blocks, and regional techniques like epidural and spinal anesthesia. Proper administration and dosage of local anesthetics is important to avoid potential toxicities.
The document discusses systemic inflammatory response syndrome (SIRS) and defines it as a systemic response to various stresses that includes symptoms like fever, increased heart rate, respiratory rate and white blood cell count. It outlines the progression from infection to bacteremia to sepsis, which involves SIRS criteria and a suspected or proven infection. The stages of sepsis like severe sepsis, septic shock and refractory septic shock are defined based on the presence of organ dysfunction or hypotension.
Transfusion-related acute lung injury (TRALI) is a potentially fatal syndrome characterized by acute respiratory distress within 6 hours of blood transfusion. It is believed to be caused by anti-leukocyte antibodies in plasma products that cause leukocyte aggregation in the lungs, inflammatory injury, and non-cardiogenic pulmonary edema. TRALI has an incidence of 1 in 5000 transfusions and mortality rate of 5-25%. Risk factors include plasma-rich products, multiparous donors, and underlying patient conditions. Diagnosis involves new pulmonary edema within 6 hours of transfusion in the absence of circulatory overload. Treatment focuses on supportive care, with most patients recovering within 72 hours. Prevention strategies include leukoreduction of blood products
1-4. Acid-base disorders. Elena Levtchenko (eng)KidneyOrgRu
IPNA-ESPN teaching course "Pediatric nephrology: Evidence-based statements and open questions", Moscow, Russia, October 22-24, 2013.
Symposium 1: WATER & ELECTROLYTE DISTURBANCES IN CHILDREN WITH CKD
Seven studies were reviewed that investigated the effects of transversus abdominis plane (TAP) blocks on postoperative opioid use and pain scores. The studies found that TAP blocks were associated with lower opioid consumption, reduced pain scores, and increased time to first request for additional analgesia compared to placebo or no block. While TAP blocks provided better pain relief and reduced opioid use, the degree of benefit varied across studies and none showed a significant reduction in opioid side effects. More research is still needed to determine the clinical implications of TAP blocks.
Magnesium plays an important physiological role as an intracellular and extracellular cation. It is involved in many metabolic processes and acts as a physiological antagonist to calcium. Hypomagnesemia can occur due to inadequate intake, excess renal losses, or redistribution. It can manifest as cardiovascular, neuromuscular, or psychiatric symptoms. Magnesium sulfate is used to treat and prevent eclampsia and preeclampsia by reducing cerebral vasospasm. It is also used for cardiovascular indications such as arrhythmias. Magnesium can impact anesthesia by potentiating neuromuscular blockade and decreasing acetylcholine release.
The document discusses acid-base balance in the human body. It defines key terms like pH, acids, bases, buffers, and how the body maintains acid-base balance through mechanisms like respiration and the kidneys. It also summarizes different acid-base disorders and their impacts on anesthesia.
Transfusion-related acute lung injury (TRALI) is a potentially fatal pulmonary complication of blood transfusion. It is caused by antibodies and bioactive substances in blood products that activate neutrophils in the lungs. TRALI accounts for 13% of transfusion-related fatalities. Risk factors include plasma-containing products and antibodies from female donors who have been pregnant. Studies show implementing male-predominant plasma transfusion strategies and HLA antibody screening can reduce TRALI cases and fatalities. However, screening also reduces the available donor pool and platelet availability. Further research is still needed to balance TRALI mitigation and adequate blood supply.
Presentation on intravenous regional anaesthesiapriadharshini31
1) Intravenous regional anesthesia (IVRA), also known as Bier block, was first introduced in 1908 by German surgeon August Bier. It involves injecting local anesthetic into the venous system of an extremity that has been isolated from circulation using a tourniquet.
2) The mechanism of action is that the local anesthetic diffuses extravascularly to block peripheral nerve branches and into vasa nervorum and ciliary plexuses of nerves, producing a peripheral and conduction block.
3) IVRA is commonly used for short surgical procedures below the elbow or knee, such as carpal tunnel release or hand surgery. It provides rapid onset anesthesia within 5 minutes when 30-50mL of 0
Regional intravenous anesthesia involves injecting local anesthetic into the venous system of an extremity isolated using a tourniquet. It was introduced in 1908 and became popular in the 1960s. The local anesthetic diffuses into surrounding veins, nerves, and skin to produce anesthesia in a centrifugal pattern. Indications include short surgeries of the upper or lower extremities. Complications can include systemic toxicity from rapid release of local anesthetic or tourniquet-related issues like compartment syndrome. Proper technique such as slow drug injection and tourniquet deflation aims to prevent complications.
This document discusses various techniques for providing anesthesia during ocular surgery, including retrobulbar, peribulbar, and sub-Tenon's blocks. Retrobulbar blocks involve injecting local anesthetic directly into the muscle cone behind the eyeball to block the oculomotor nerves. Peribulbar blocks inject anesthetic in the space surrounding the eye muscles. Sub-Tenon's blocks make a small incision in Tenon's capsule to inject anesthetic beneath it. Each technique has advantages and disadvantages in terms of onset/duration of anesthesia, risk of complications, and ability to achieve akinesia.
Post operative emergency management in periodonticsParth Thakkar
The document summarizes several common postoperative complications that can occur following periodontal surgery, including shock, hemorrhage, pain, swelling, infection, and allergic reactions to dressings. It provides details on the causes, signs and symptoms, and management of each complication. The most serious complication is shock, which requires immediate emergency treatment, while minor issues like pain can usually be managed with medication. Proper postoperative instructions and follow-up are important to address any complications promptly.
This document provides information on epidural anesthesia. It discusses the anatomy of the epidural space, techniques for epidural anesthesia, types of epidurals, spread of local anesthetics in the epidural space, catheter placement, pain assessment, and common medications used including local anesthetics and opioids. Potential complications are also reviewed. The document compares epidural anesthesia to spinal anesthesia, noting differences in injection site, identification of spaces, doses, onset of action, density of block, and risk of headache.
Local anesthesia is used to induce numbness in a specific part of the body. This document discusses types of local anesthetics, their maximum doses, potential complications from local anesthesia administration including needle breakage, prolonged numbness, nerve injury, swelling, and allergic reactions. It provides guidance on managing these complications through reassurance, medication, heat/ice therapy, observation, and referral to a specialist if needed. Systemic toxicity is also addressed, with levels of severity and corresponding emergency treatment procedures.
This document discusses various regional anesthetic techniques including:
- Topical anesthesia which uses creams or ointments to numb skin and mucous membranes.
- Intravenous regional anesthesia (Bier block) which involves injecting local anesthetic around a tourniqueted limb to numb it.
- Peripheral nerve blocks which involve injecting local anesthetic near specific nerves to numb surgical areas. Brachial plexus and lumbar plexus blocks are examples.
- Potential complications include local tissue damage, nerve injury, seizures and cardiac issues if too much drug is absorbed systemically. Proper technique and drug choice can minimize adverse outcomes.
a case of burn with post burn contracture posted for surgeryZIKRULLAH MALLICK
This document provides information on the classification, causes, and treatment of burn injuries. It discusses:
- The classification of burns as superficial (1st degree), partial thickness (2nd degree), full thickness (3rd degree), and deep full thickness (4th degree) based on the depth of tissue damage.
- Common causes of burns including scalds, fires, chemicals, and electricity. Burns can also be classified as thermal, chemical, electrical or radiation.
- Estimating burn size using the Rule of Nines or Rule of Fives.
- Considerations for fluid resuscitation to correct fluid shifts using formulas like Parkland or Brooke.
- Potential complications involving multiple organ
This document provides information on the history and types of local anesthesia. It discusses key details such as:
- Carl Koller demonstrated the first clinical use of local anesthesia in 1884 using procaine. Lidocaine was developed in 1948 and widely used.
- Local anesthesia involves topical anesthetics or local infiltration of drugs like lidocaine to numb circumscribed body areas.
- Common uses are for excision procedures, dentistry work, dermatology procedures and biopsies. Potential risks include infection, hematoma, and nerve damage.
Compartment syndrome is a serious condition caused by increased pressure within the fascial compartments of the body that can compromise blood flow. It requires immediate medical attention to prevent permanent muscle and nerve damage. The condition is diagnosed based on severe pain out of proportion to the injury that is worsened with stretching of the affected muscles. Treatment involves surgical fasciotomy to release the pressure within the compartments. Early diagnosis and treatment are essential to avoid long-term complications.
Burns management presentation by 2nd yr MSC nursing studentSigymol John
this ppt deals with the management part of burns, mainly divided as pre-hospital care, emergent phase,acute phase and rehabilitation phase along with nursing management,nursing diagnosis and interventions.
This document provides information on different types of anesthesia. It begins by defining anesthesia as a partial or total loss of sensation with or without loss of consciousness. It then discusses the history and development of anesthesia using various agents such as ether and chloroform. It describes the purposes, selection factors, and classifications of anesthesia including general anesthesia and local/regional anesthesia. The document elaborates on techniques, stages, complications, and medications used for different types of anesthesia such as general, local, spinal, epidural, and peripheral nerve blocks.
The document discusses the specialized care provided to patients in the post-anesthesia care unit (PACU) after surgery. It outlines that the PACU should be located near the operating theater and have sufficient space and monitoring equipment to care for postoperative complications. Common complications addressed include hypoxia, hypotension, pain, nausea and the importance of fluid management. Vital signs and urine output must be monitored closely in the PACU to optimize patient recovery.
regional and topical ocular anaesthesia in ophthalmologyvaibhavkapadia3
This document discusses various techniques for regional anesthesia for ophthalmic procedures. It describes the anatomy of the orbital spaces and different local anesthetics used. Methods covered include retrobulbar, peribulbar, sub-Tenon's, and facial nerve blocks. Complications of retrobulbar block like hemorrhage and globe perforation are also summarized.
This document provides a history of local anesthetics from ancient times to modern drugs like lidocaine and bupivacaine. It discusses the definition and classification of local anesthetics, how they work, and their mechanisms of action. Examples of commonly used local anesthetics are presented, including details about their onset, duration, dosing, and metabolism. The document also covers local anesthetic administration techniques and necessary armamentarium. In summary, it provides a comprehensive overview of the development and use of local anesthetics in oral and maxillofacial surgery.
The document discusses the specialized care provided to patients in the post-anesthesia care unit (PACU) after surgery. It outlines important considerations for the PACU including location, size, equipment, and monitoring of patients. Common complications in the postoperative period like hypoxia, hypotension, arrhythmias, hypothermia, and pain are described along with their management. The importance of fluid balance, temperature monitoring, and care of tubes/drains is emphasized.
this ppt material is about physiotherapy techniques in animal, this is all about how we can aid our pets with physiotherapy treatment for their wealth.
The document discusses various aspects of physiotherapy, including its history, definition, aims, principles, categories, and methods. Physiotherapy originated in ancient times but was established as a modern science in the 19th century due to injuries sustained in World War 2. It aims to restore function and mobility through physical means without the use of drugs, using methods like heat therapy, massage, hydrotherapy, exercise and electricity.
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
This document provides an introduction to local anesthesia. It discusses that dentists, not doctors, were responsible for discovering anesthesia due to their motivation to alleviate pain from dental procedures. The first two people to introduce anesthesia were dentists - Horace Wells with nitrous oxide in 1844 and William Morton with ether. Local anesthesia works by preventing the generation and conduction of nerve impulses, setting up a chemical roadblock between the source of pain and the brain. The document then discusses the mechanism of action, factors affecting local anesthetics, and uses and contraindications of local anesthesia.
Ähnlich wie Bier block (intravenous regional anesthesia) (20)
Drug profiles of Vancomycin, Prednisone and SalbutamolKomal Haleem
Vancomycin is a glycopeptide antibiotic used to treat infections caused by Gram-positive bacteria including infections of the intestines that cause colitis. It is available as capsules, oral powder, and injectable forms in various strengths from 125mg to 10g. Vancomycin works by inhibiting cell wall synthesis in bacteria. It has various uses to treat infections and is mostly excreted unchanged in urine. Common side effects include nausea, diarrhea, and red man syndrome. Dosage depends on the infection being treated and is adjusted in renal impairment.
ROLE OF PHARMACIST IN PREVENTION & MANAGEMENT OF DRUG INTERACTIONSKomal Haleem
The pharmacist plays an important role in preventing and managing drug interactions. Through taking a thorough medication history, checking for interactions, educating patients, and monitoring treatment, the pharmacist can help avoid dangerous interactions. In one case study, a patient suffered an accident due to an interaction between Xanax and Ultram that was prescribed by different doctors. It is important for pharmacists to be aware of a patient's full drug history to catch potential interactions and ensure safe usage of medications.
Sesame oil is extracted from the seeds of the sesame plant through processes like expeller pressing or solvent extraction. It has a high smoke point and shelf stability, making it suitable for cooking. Sesame oil also has several medicinal and skin benefits due to its antioxidant and anti-inflammatory properties, such as treating skin infections, reducing cholesterol, and protecting the skin. It is a popular cooking oil in Asia and used in massages and hair and skin treatments in some cultures.
Tablet excipients serve several important functions in tablet manufacturing including improving properties like flow, stability, and bioavailability. Common excipients include diluents, binders, disintegrants, and lubricants. Tablets can be classified based on their route of administration, drug delivery system, and manufacturing method. Key types include compressed, enteric coated, chewable, sublingual, and effervescent tablets. Excipients allow tablets to be designed for rapid or delayed drug release depending on the therapeutic need.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
2. HISTORY
August Bier introduced this block in 1908.
In 1963, Holmes popularized the Bier Block.
Completed within 40-60 minutes.
Onset of anesthesia is rapid and reasonable
muscle relaxation.
3. CONDITIONS
1.Surgical procedures involving the arm below the
elbow.
2.Surgical procedures involving the leg below the knee.
Ensure that the patient has been fasting for an
appropriate period of time.
5. There appears to be multiple and complementary
mechanisms for producing analgesia and anesthesia.
FACTORS RESPONSIBLE:
A large volume of dilute anesthetic
Ischemia
Asphyxia
Hypothermia
Acidosis
6. HYPOTHERMIA&ACIDOSIS
Hypothermia and acidosis results in enhanced local anesthetic activity.
ASPHYXIA
Asphyxia occurs at 20-30 mins complementing local anesthetic action.
Local anesthetic molecules transverse venous walls into surrounding
tissue.
INJECTION OF LOCAL ANESTHETIC
Initial analgesia produced by local anesthetic action on major nerve
trunks, small nerves, and nerve endings.
SEQUENCE EVENTS RESULTING IN ANESTHESIA &
ANALGESIA:
7. EQUIPMENTS
A standard regional anesthesia tray is prepared with the
following equipment:
22-gauge intravenous catheter
Flexible extension tubing
5" Esmarch bandage
Double cuff tourniquet
20 mL syringes with local anesthetic
Pressure source
A double-cuff tourniquet
8. PROCEDURE:
1. A small IV intravenous catheter (e.g, 22-gauge) is
introduced in the dorsum of the patient's hand of the
arm to be anesthetized. The patient is in the supine
position.
9. 2. A tourniquet is
placed on the proximal
arm of the extremity to
be blocked. We use a
"double cuff" to increase
the reliability of the
technique and help reduce
the tourniquet pressure pain.
11. 4. Apply wide Esmarch rubber
bandage to complete the
exsanguination of the
extremity.
12. 5.Elevate arm to promote
venous drainage. The
Esmarch is then unwrapped
and the extremity is checked
for color (pale skin) and
arterial occlusion
(absence of the radial pulse).
13. 6.The extremity is then lowered
and the local anesthetic is
slowly injected through the
previously inserted IV
catheter.
14. POST PROCEDURE
Analgesia will occur within 3-4 minutes.
Even if the surgery is completed within a few minutes,
on no account should the tourniquet be deflated until at
least 15 minutes has passed.
The pressure in the tourniquet must be constantly
observed and maintained at least 50mm Hg above the
patient's systolic blood pressure.
15. If the operation is prolonged, the patient may
complain of pain due to pressure from the
tourniquet. This may be reduced either by the
subcutaneous infiltration of a few mls of local
anesthetic above the tourniquet or by the use of a
"double tourniquet technique”.
At the end of the procedure, the tourniquet is
deflated and normal sensation quickly returns.
The tourniquet is reinflated again 20-30 seconds.
16. ADVANTAGES OF THE BIER BLOCK
Easy to administer
Low incidence of block failure
Safe technique when used appropriately
Rapid onset and recovery
Patient is awake during procedure.
Controllable extent of anesthesia.
17. DISADVANTAGES OF THE BIER BLOCK
Should be used for only short procedures
Patient may experience tourniquet pain after
20-30 minutes
Sudden cardiovascular collapse or seizures
may occur if local anesthetic is released into
the circulation too early.
Lose pulse
Rapid recovery may lead to postoperative
pain
Difficulty in providing a bloodless field
18. CONTRAINDICATIONS
Reynaud’s disease
Homozygous sickle cell disease
Young children
Unreliable or inadequate tourniquets.
Shock
Multiple trauma (crush injuries of relevant
limb)
Hypersensitivity to Prilocaine or lidocaine
Seizure disorder
19. DRUGS
1.PRILOCAINE
The drug of choice as it is least toxic
largest therapeutic index.
One complication is methemoglobinemia . Prilocaine is
metabolized to o-toluidine derivatives, which converts
hemoglobin to methemoglobin.
onset 2 - 15minute and duration 1 – 4hours.
2.BUPIVACAINE
not suitable
it is too toxic, particularly to the myocardium.
Slower onset .
20. 3.LIGNOCAINE
acceptable alternative.
onset 1.5 - 5minute and duration 1 – 4hours
DOSAGE
the arm dosage can be: 30-40 ml of 0.5%
prilocaine or 0.5 % lidocaine.
In leg, larger volumes 50-60 ml.
22. 4. Toxicity of local anesthetics
Signs and symptoms may include nausea,
vomiting, dizziness, tinnitus, funny sensation
around the mouth, loss of consciousness.
Local Anesthetic Toxicity Management
Use the A, B, C’s for the management of local
anesthetic toxicity.
A= airway. administer 100% oxygen.
B= breathing. May need to assist the patient with
positive pressure ventilation or intubation.
C= circulation. Check for a pulse..
23. CONCLUSION
IVRA is a simple and valuable technique that is
easy to learn and perform. It is very safe
provided excessive doses of local anesthetic are
avoided, if the tourniquet pressure is carefully
monitored and if resuscitation equipment is
always immediately available.