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In this episode of the AnesthesiaExam podcast, New York Anesthesiologist, David Rosenblum, MD delves into the topic of maternal physiological changes during pregnancy and the associated concerns for anesthesia providers. The episode emphasizes the importance of understanding these changes to ensure safe and effective anesthesia management for pregnant patients.
Dr. Rosenblum discusses the significant physiological changes that occur during pregnancy, particularly in the cardiovascular, respiratory, and hormonal systems. These changes impact drug distribution, elimination, ventilation, and the risk of aspiration.
Throughout the discussion, the host and guest highlight the need for anesthesia providers to stay updated on the latest evidence-based practices and guidelines for managing pregnant patients. They stress the importance of appropriate dosing, ventilation strategies, and addressing the increased risk of aspiration to maintain the well-being of both the mother and the fetus.
To further support Anesthesiologists and CRNAs in their board exam preparation, we are offering the NRAP AnesthesiaExam board review course. The course is designed to provide comprehensive coverage of anesthesia with lectures, videos and question bank to ensure candidates are well-prepared for their exams. Listeners are encouraged to visit https://www.nrappain.org/courses/BasicAnesthesiaExam to access more information and register for the course.
The NRAP Academy is offering the exciting opportunity for anesthesia professionals interested in regional anesthesia ultrasound to train at one of our live ultrasound CME workshops. Dr. Rosenblum mentions regional anesthesia ultrasound courses in NY, the US and abroad.
These courses offer valuable hands-on training and insights into the latest techniques. Our course calendar is listed here:
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For more information and to register for the regional anesthesia ultrasound courses,
Reference
Ruth Bedson, MBBS FRCA , Anna Riccoboni, MBChB FRCA, Physiology of pregnancy: clinical anaesthetic implications, Continuing Education in Anaesthesia Critical Care & Pain, Volume 14, Issue 2, April 2014, Pages 69–72, https://doi.org/10.1093/bjaceaccp/mkt036
Neurosurgery and Regional Anesthesia
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In this episode, we will explore the various regional anesthesia techniques used in neurosurgery, specifically focusing on blocks for head, neck, and spinal surgeries.
Segment 1: Blocks used in Head and Neck Surgeries
- Scalp Block:
- The scalp block involves blocking six nerves that provide sensory innervation to the scalp.
- It is performed by subcutaneous infiltration of local anesthetics (such as bupivacaine, ropivacaine, or levobupivacaine) for each nerve.
- Ultrasound guidance has improved the precision of block administration.
- The main indication for a scalp block is awake craniotomy, but it is also used in other procedures like deep brain stimulation and cranioplasty surgery.
- Scalp block offers advantages such as accurate neurological evaluation, pre-emptive analgesia, and hemodynamic stability during surgery.
- It also reduces postoperative pain, the need for rescue analgesics, and pain scores in the early postoperative period.
- Infraorbital Block (IOB):
- The infraorbital nerve block targets the infraorbital nerve, which supplies the skin and mucous membrane of the upper lip, lower eyelid, and cheek.
- The IOB can be performed using the classical landmark technique or ultrasound guidance.
- Ultrasound guidance provides real-time visualization and accurate needle placement.
- IOB combined with general anesthesia is beneficial for postoperative pain relief in procedures like endoscopic trans-nasal trans-sphenoidal (TNTS) approach for pituitary tumor excision.
- Other regional techniques like sphenopalatine ganglion block and maxillary nerve blocks have also been attempted for transsphenoidal surgeries.
- Trigeminal Nerve Block:
- Trigeminal nerve block is used for patients unresponsive to medical management of trigeminal neuralgia.
- Traditionally performed using the paresthesia technique, ultrasound guidance allows real-time visualization and confirmation of local anesthetic spread.
- Ultrasound guidance helps locate the Gasserian ganglion and visualize the trigeminal ganglion, providing a safe and radiation-free procedure for pain relief.
Segment 2: Blocks used for Spinal Surgeries
- Cervical Plexus Block (CPB):
- CPB is commonly used in carotid endarterectomy (CEA) and cervical spine surgery.
- Different levels of CPB can be performed depending on the depth of injection.
- Superficial CPB involves injecting local anesthetic superficially into the deep cervical fascia.
- Deep CPB requires depositing local anesthetic deep to the prevertebral fascia.
- CPB helps in monitoring cerebral blood flow during CEA and provides postoperative pain relief.
- Ultrasound guidance can be used for superficial CPB, ensuring accurate needle placement and local anesthetic spread.
- Erector Spinae Block (ESB):
- ESB is used for pain control in spinal surgeries.
- It involves depositing local anesthetic in the plane between the erector spinae muscle and the transverse process.
- ESB provides effective postoperative analgesia and reduces opioid consumption.
Regional anesthesia techniques play a crucial role in neurosurgery, providing effective pain relief and improving patient outcomes. Blocks like scalp block, infraorbital block, trigeminal nerve block, cervical plexus block, and erector spinae block offer numerous advantages in specific procedures. Ultrasound guidance has enhanced the precision and safety of block administration. These techniques contribute to improved surgical outcomes and patient satisfaction in neurosurgical procedures.
Upcoming Courses and Workshops!
Course Calendar
Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!
Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For up to date Calendar, Click Here!