Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 58: Medications For Neuraxial Anesthesia with Dave Berman and Anh Nguyen
Oct 11, 2017
In this episode, OB Anesthesia fellows Dr. Dave Berman and Dr. Anh Nguyen discuss medications for neuraxial anesthesia, including local anesthetics, opioids, and adjuncts such as clonidine and epinephrine. They delve into topics like the basic science of local anesthetics, the use of fentanyl in neuraxial anesthesia, and the controversy surrounding the use of sodium bicarbonate. They also explore the benefits and drawbacks of clonidine as an adjuvant, and touch on experimental medication practices involving magnesium, ketamine, and neostigmine. Exciting insights for those interested in anesthesia!
54:35
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Quick takeaways
- Epinephrine is commonly added to local anesthetics in neuraxial anesthesia to increase block density and duration, but caution is needed due to potential hypotension and bradycardia.
- Sodium bicarbonate can be added to enhance the onset and quality of nerve blocks, but precipitation and hypotension should be monitored.
Deep dives
Epinephrine as a Common Adjuvant in Niraxial Blockade
Epinephrine is commonly added to local anesthetics in epidurals and spinal injections to increase the block density, reduce systemic absorption, and prolong the duration of action. It is more effective when combined with lidocaine and ropivacaine, and is not recommended for use with bupivacaine. However, caution is needed as it can cause hypotension and bradycardia, especially in patients with preeclampsia.
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