Anesthesia Nerve Sensitivity Autonomic gtgt Sensory gtgt Motor Neuraxial Spinal Epidural Caudal Peripheral Nerve Block IV Regional Bier block Spinal Anesthesia ID: 909772
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Slide1
Regional Anesthesia
Slide2What is Regional Anesthesia
?
Slide3Slide4Nerve Sensitivity
Autonomic
>> Sensory >> Motor
Slide5Slide6Neuraxial
Spinal
Epidural
Caudal
Peripheral Nerve Block
IV Regional ( Bier block )
Slide7Spinal
Anesthesia
Slide8Slide9Slide10Slide11Local Anesthetic Physiology
Hyperbaric
(
Dextrose)
Isobaric
Hypobaric
Slide12Spread of Local Anesthesia
•
Baricity
of Local
Anesthetic
• Position of Patient
• Concentration of Local
Anesthetic
• Volume Injected
• Level of Injection
• Speed of Injection
Slide13Advantages
• Cheap
• High Patient Satisfaction
• Well Tolerated in Pulmonary Disease
• Maintain Patent Airway
• Selective Muscle Relaxation
• Decreased Blood Loss
• Decreased Incidence of DVT and PE
Slide14Disadvantages
• Difficult Placement in Elderly
• Hypotension
• Patient Can Talk
• Patient Anxiety
• Not Reliable for Surgery > 2 hours
Slide15Complications
•
Bleeding
• Post-Dural Puncture Headache
• Transient Neurological
Syndrome
• Total
Spinal
Slide16Total Spinal
• Hypotension
•
Bradycardia
• Arm involvement
• Shortness of Breath
• Patient Anxiety
• Loss of Consciousness
Slide17Contra-Indications
•
Inadequate equipment for GA
• Bleeding
Dyscrasia’s
•
Hypovolemia
• Patient Refusal
• Sepsis/
Bactermia
• Anatomic Deformities of the Spine
• Neurological Disease
• Increased ICP
• Fixed Cardiac Output States
Slide18Epidural
Anesthesia
Slide19Slide20Slide21Uses
•
Hip and Knee Surgery
• Lower Extremity Vascular Surgery
• Lower Extremity Amputation
• Obstetrical –
Labor
& C/S
• Thoracic Surgery – Post-Op Pain Control
• Thoracic Trauma
• Abdominal Surgery – Post-Op Pain
Control
Slide22Advantages
•
Cheap
• High Patient Satisfaction
• Well Tolerated in Pulmonary Disease
• Maintain Patent Airway
• Selective Muscle Relaxation
• Decreased Blood Loss
• Decreased Incidence of DVT and PE
Slide23Disadvantages
•
Difficult Placement in Elderly
• Hypotension
• Patient Can Talk
• Patient Anxiety
Slide24Complications
• High Epidural
• Local
Anesthetic
Toxicity
• Total Spinal
• Accidental Dural Puncture
Slide25Contra-Indications
• Patient Refusal
•
Coagulopathy
• Localized Skin Infection
• Elevated ICP
•
Hypovolemia
• Uncooperative Patient
• Pre-Existing Neurological Disease
• Spinal Column Abnormalities
• Fixed Cardiac Output States
Slide26Peripheral Nerve Blocks
Slide27•
Brachial Plexus
•
Psoas
Compartment Block
• Femoral Nerve Block
•
Popliteal
Fossa
Block
• Ankle Block
Slide28Slide29Slide30Slide31Slide32Intravenous Regional Anesthesia
( Bier block )
Slide33Slide34Applications
•
Distal Arm Surgery
• Useful for Short Procedures
Slide35Contra-Indications
•
Sickle Cell Disease
• Crush Injury to the Limb
• Very Young may need additional
Slide36Complications
• Local
Anesthetic
Toxicity
Slide37THANK YOU