Search

Background: Deviation of the anterior nasal spine (ANS) is a common cause of caudal nasal septal deviation. In our experience, relocation of the deviated ANS is a useful technique in the correction of the caudal septal deviation. Objectives: To describe our experience with the ANS relocation technique in isolation and in combination with other techniques for correction of caudal septal deviation. Methods: A retrospective chart review was performed on cases of ANS relocation. Results: A total of 378 patients underwent ANS relocation over 4 years. Complete straightening of the septum occurred in 312 cases (82.5%), and significant improvement with mild remnant deviation occurred in 66 cases (17.5%). No patients had severe remnant deviation. None of the patients requested for revision surgery. A total of 351 patients (92.9%) experienced significant subjective improvement in bilateral nasal airflow, while 27 patients (7.1%) experienced mild improvement in bilateral nasal airflow. None of the patients had worsened airflow after surgery. Conclusion: The ANS relocation technique is a useful and effective technique which can be used in isolation or in combination of other techniques for the correction of caudal septal deviation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Introduction Single-shot caudal analgesia is a useful technique in controlling postoperative pain in infraumbilical pediatric surgeries, although of a limited duration. The aim of this study was to evaluate the analgesic efficacy and rate of success when incorporating dexmedetomidine or fentanyl to levobupivacaine in ultrasound (U/S)-guided caudal block for infraumbilical surgeries. Patients and methods This prospective, randomized, double-blinded study was conducted on 63 pediatric patients undergoing infraumbilical surgeries, allocated into three groups to receive inhalational anesthesia with an appropriately sized laryngeal mask airway, followed by U/S-guided caudal epidural block using either only 0.25% levobupivacaine (L), or incorporating it with 1 μg/kg fentanyl (LF) or 1 μg/kg dexmedetomidine (LD) in a total volume of 0.7 ml/kg. Pain assessment using Children's and Infants' Postoperative Pain Scale (CHIPPS) score, time to first analgesic, and total analgesia required in the three groups and Ramsay sedation score were recorded. Hemodynamics and any adverse effects were also documented. Results None of the patients required intraoperative additional analgesia. A statistically significantly lower postoperative CHIPPS values with prolonged analgesic duration and time to rescue analgesia was observed in the levobupivacaine-fentanyl and levobupivacaine-dexmedetomidine groups (275±20.62 and 304.75±25.2, respectively) as opposed to the levobupivacaine only group (203.1±18), with an evident reduction in the total paracetamol dose required postoperatively (P<0.001). Arousable sedation time was significantly prolonged in the levobupivacaine-fentanyl and levobupivacaine-dexmedetomidine groups. Apart from pruritus and urine retention in the levobupivacaine-fentanyl group, no adverse events were recorded in all groups. Conclusion Caudal levobupivacaine combined with dexmedetomidine 1 μg/kg in pediatric patients undergoing infraumbilical surgeries provides prolonged postoperative analgesia comparable to levobupivacaine-fentanyl and superior to levobupivacaine alone, with reduced postoperative analgesic requirements and extended arousable sedation time. The use of U/S raises the safety and ensures the success of caudal block. [ABSTRACT FROM AUTHOR]

Epidural analgesia confers significant perioperative advantages to neonates undergoing surgical procedures but may be very technically challenging to place using a standard interlaminar loss-of-resistance to saline technique given the shallow depth of the epidural space. Thoracic epidural catheters placed via the caudal route may reduce the risk of direct neural injury from needle placement, but often pose higher risks of infection and/or improper positioning if placed without radiographic guidance. We present a detailed method of placing a fluoroscopically guided, tunneled transcaudal epidural catheter, which may reduce both of these risks. The accuracy and precision of this technique often provides adequate analgesia to allow for opioid-free epidural infusions as well as significant reductions in systemic opioids through the perioperative period. Opioid-free analgesia using a regional anesthetic technique allows for earlier extubation and reduced perioperative sedation, which may have a less deleterious neurocognitive effect on the developing brain of the neonate. [ABSTRACT FROM AUTHOR]

Purpose: 'Hockey stick incision' used in renal transplant is large enough to cause severe postoperative morbidity especially in pediatric recipients. Although epidural analgesia is known to be effective in pain control, the resulting sympathectomy might affect hemodynamics interfering with the transplant process. In our study, we evaluated the feasibility and safety of inserting an epidural catheter to the thoracic level via the caudal route, and the effect of using epidural local anesthetics at low concentrations on hemodynamics. Methods: After approval from the ethical committee at Kasr Al Ainy University Hospital and consent from parents/legal guardians, sixty patients aged 3-12 years who were scheduled for renal transplant were randomly divided into two equal groups. Group I (epidural group) received continuous caudal epidural bupivacaine 0.125 % with fentanyl together with intravenous (IV) fentanyl and paracetamol. Group II (control group) received only IV fentanyl and paracetamol. Intraoperative data included heart rate (HR), mean arterial blood pressure (MAP) and central venous pressure (CVP). Postoperative variables included HR, MAP, CVP, pain score and complications. Results: Threading failure via the caudal route occurred in 6.67 % of cases. Intraoperative differences in hemodynamics and CVP were not clinically significant between groups. Postoperative HR, MAP, and CVP were generally higher in the control group. Pain control was more satisfactory and postoperative complications were less in the epidural group. Conclusion: Caudal epidural anesthesia in pediatric renal transplant is a valuable addition to general anesthesia as it provides stable perioperative hemodynamics, excellent postoperative analgesia and is associated with fewer complications than narcotic-dependent analgesia. Clinical trial registration number: NCT02037802 [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of fluoroscopic guided transforaminal steroid versus interlaminar epidural steroid versus caudal steroid.Material and Method: A total of 90 patients were studied who had complains of low back pain with radiculopathy and MRI evidence of disc prolapse. Out of this group, patients were randomly assigned to three groups each having 30 patients. First group received transforaminal steroid injection, second group received caudal steroid injection, and third group received epidural steroid. All patients were followed up for 12 months, and the results were compared using change in Visual Analogue Scale score and Oswestry Disability Index (OSD).Results: The change in pain scores was statistically different at 1- and 6-month interval such that a higher change was observed by transforaminal route as compared to the other two. There was no difference in change of scores between interlaminar and caudal routes. For OSD, a greater change was seen in transforminal at all times as compared to the other two. There was no difference in change of scores between interlaminar and caudal routes at any time of assessment.Conclusion: In current study, transforaminal steroid injection group has better symptomatic improvement for both short and long term as compared to interlaminar and caudal steroid injection group. [ABSTRACT FROM AUTHOR]

Purposes: Caudal block is one of the most commonly used anesthetic techniques in subumbilical and genitourinary procedures. However, traditional administration of caudal levobupivacaine was inadequate on blocking peritoneal response during spermatic cord traction. The aim of this study was to evaluate whether the addition of caudal sufentanil to levobupivacaine provided better analgesia for children undergoing orchidopexy. Methods: Sixty-two patients, scheduled for right orchidopexy, received caudal block after induction. Group LS ( n = 31) received levobupivacaine 0.25 % 1 ml/kg plus sufentanil 0.5 μg/kg, and group L ( n = 31) received levobupivacaine 0.25 % 1 ml/kg only. HR or MAP fluctuation >20 % or entropy increase >15 % during spermatic cord traction was defined as inadequate anesthesia and was treated with increasing sevoflurane concentration. The number of children who needed sevoflurane rescue was counted, and postoperative side effects and quality of sleep were also recorded. Results: There were no statistically significant differences between the two groups in age, weight, and duration of surgery. Two (6.45 %) children in group LS required inspired sevoflurane rescue to block hemodynamic fluctuation during spermatic cord traction, as compared with 12 (38.71 %) patients in group L ( P < 0.001). At the time of exerting spermatic cord traction, the median HR was, respectively, 134 and 145 ( P < 0.001); the corresponding response entropy (RE) and state entropy (SE) was 65 and 54, respectively, in group LS versus 76 and 65 in group L ( P < 0.001). Conclusion: In pediatric orchidopexy, the addition of sufentanil to levobupivacaine for caudal blockade offers clinical benefit over levobupivacaine alone in blocking the spermatic cord traction response. [ABSTRACT FROM AUTHOR]

Recently, most studies reported magnesium as a N-methyl-D-aspartate receptor antagonist and its analgesic and perioperative anaesthetic effects have been discussed with central desensitization pathway. We investigated the effects of caudal ropivacaine plus magnesium and compared with ropivacaine alone on postoperative analgesia requirements. After hospital ethic committee's consent, 60 patients (ASA I-II, 2-10 years old) who had lower abdominal or penoscrotal surgery were enrolled in the study. After general anaesthesia induction, caudal blockage was applied. Patients were randomly assigned in two groups. Ropivacaine 0.25% was administered to Group R (n=37), ropivacaine 0.25% plus 50 mg magnesium to Group RM (n=23) in 0.5 ml kg-1 volume. Postoperative analgesia level was recorded at 15 min and 1, 2, 3, 4, 6 h by using Paediatric Objective Pain Scale (POPS) and The Children's Hospital of Eastern Ontoria Pain Scale (CHEOPS). Postoperative motor blocks were evaluated with Modified Bromage Motor Block Scale. According to demographic characteristics, there were no significant differences between the two groups (P>0.05). POPS, CHEOPS, Bromage Motor Scales, analgesia duration and adverse effects were similar in Group R and Group RM. It has been shown that addition of magnesium as an adjuvant agent to local anaesthetics for caudal analgesia has no effect on postoperative pain and analgesic need. [ABSTRACT FROM AUTHOR]

Copyright of Stomatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We report the characterization of a caudal gene from the rhizocephalan cirripede Sacculina carcini and its embryonic and larval expression patterns. Cirripedes are maxillopodan crustaceans that are devoid of any complete abdominal segment at the adult stage. We currently explore the genetic basis of this peculiar body plan. In a previous study we have shown that they probably lack the abdominalA gene, while possessing the other Hox genes shared by arthropods. However, at least a part of the genetic program might be conserved, since the engrailed.a and engrailed.b genes are expressed in a posterior region that we interpret as a relic of an ancestral abdomen. Here we show first that the Sacculina caudal gene is expressed early in embryogenesis, which makes it the earliest genetic marker evidenced in the development of Sacculina and of any other crustacean species. It is expressed later in the embryo in the caudal papilla, a posterior proliferating zone of cells. During the larval stages, the caudal gene is first expressed in the whole thoracic region; then its expression regresses to the posterior end of the larva. Surprisingly, it is never expressed in the vestigial abdomen. This lack of expression of the Sacculina caudal gene in a posterior region, at odds with what is known in all other studied metazoan species, might be correlated with the defective development of the abdomen. [ABSTRACT FROM AUTHOR]

Copyright of Calcified Tissue Research is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Postoperative pain relief by caudal epidural buprenorphine, a highly lipid-soluble, semisynthetic derivative of thebaine, has not been reported in children. Over a period of 1 year, 58 children undergoing various surgical procedures were given 3 μg/kg epidural buprenorphine via the caudal route. No serious side effects were encountered; on the contrary, the excellent and long-lasting pain relief (about 7 days) observed in the majority (91.38%) of the cases as compared with other opioids should go a long way toward reducing the psychological trauma otherwise suffered by children undergoing hospitalization and surgery. [ABSTRACT FROM AUTHOR]