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Central neuraxial blocks (CNBs), which include spinal, epidural, and combined spinal epidural injections, are indispensable techniques in the anesthesiologist's armamentarium. Indeed, in scenarios such as when dealing with the obstetric population, patients with obesity, or patients having respiratory compromise (e.g., lung disease or scoliosis), CNBs are the mainstay for anesthesia and/or analgesia. Traditionally, CNBs are performed using anatomical landmarks, which are simple, easy to master, and exceptionally successful in most cases. Nevertheless, there are notable limitations with this approach, especially in scenarios where CNBs are considered mandatory and vital. Any limitation of an anatomic landmark-based approach is an opportunity for an ultrasound-guided (USG) technique. This has become particularly true for CNBs, where recent advances in ultrasound technology and research data have addressed many of the shortcomings of the traditional anatomic landmark-based approaches. This article reviews the ultrasound imaging of the lumbosacral spine and its application for CNBs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The caudal block and transversus abdominis plane block (TAP) are commonly used in combination with general anesthesia for pediatric lower abdominal, inguinal, and genitourinary surgeries. There is limited data directly comparing the impact of these techniques on recovery. In this meta-analysis, we compare the duration of postoperative analgesia between these two techniques., Objective: This review examined the duration of analgesia in pediatric patients (age 0-18 years) undergoing surgery who received caudal or TAP block after induction of general anesthesia. The primary outcome was duration of analgesia, defined as the time to first rescue analgesic dose. Secondary outcomes included number of rescue analgesic doses, acetaminophen usage within 24 h postoperatively, 24 h pain score area under the curve, and postoperative nausea and vomiting., Evidence Review: We systematically searched Pubmed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts from prominent 2020-2022 anesthesia conferences for randomized controlled trials that compared these blocks and reported analgesia duration., Findings: Twelve RCTs inclusive of 825 patients were identified. TAP block was associated with longer analgesia duration (Mean difference = 1.76 h, 95% CI: 0.70-2.81, p  = 0.001) and reduced doses of rescue analgesic within 24 h (Mean difference = 0.50 doses, 95% CI: 0.02-0.98, p  = 0.04). No statistically significant differences were detected in other outcomes., Conclusion: This meta-analysis suggests that TAP block provides greater duration of analgesia than caudal block after pediatric surgeries. TAP block was also associated with fewer rescue analgesic doses in the first 24 h without increased pain scores., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=380876, identifier: CRD42022380876., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Hafeman, Greenspan, Rakhamimova, Jin, Moore and Al Bizri.)

El objetivo de este trabajo es realizar una estimación cuantitativa de la cantidad de agua aportada por la precipitación diaria al caudal del río Uruguay y del tiempo de retardo de la onda de crecida en sus diferentes subregiones. Se escogió como área de trabajo a la región superior de la cuenca del río Uruguay comprendida entre 26ºS-32ºS y 48.5ºW- 60.5ºW donde el dominio fue dividido en tres subcuencas (alta, media y baja). El análisis fue realizado para el período 1970-2001. Se empleó la triangulación de Delaunay como variante del método de Polígonos de Thiessen en el cálculo de la precipitación areal. Asimismo se estimó la onda de crecida para cada subregión en función de tormentas seleccionadas. Se determinó que una precipitación importante en la subcuenca alta o media, demoraría alrededor de 8 días en ser detectada en los registros de caudal de Paso de los Libres y 10 días en Salto Grande. A su vez, una lluvia intensa en la subcuenca baja tardaría alrededor de 2 días en ser detectada en los registros de caudal de Salto Grande.The main objective of the present work is the quantitative estimation of the discharge contributed by the daily rainfall to the Uruguay River discharge and the determination of the lag of the flood wave of the precipitation in each region. Due to its characteristics, the upper region of the basin of the Uruguay River comprised between 26ºS- 2ºS and 48.5ºW-60.5ºW was selected for this study where the domain was divided in three different sub-basins: upper, central and lower. The period considered for the present analysis was 1970-2001. A triangulation of Delaunay as a variant of the method of Thiessen Polygons was used in the calculation of the areal rainfall. Then, the flood wave for each sub-basin was calculated based on selected storms. Results show that an intense precipitation event in the upper or central sub-basins has an 8-days lag before its detection in the Paso de los Libres discharge and a 10- days lag in the case of Salto Grande discharge. Likewise, an intense rainfall over the lower sub-basin has a 2-days lag before being noticed in the Salto Grande discharge.

La compensación por servicios ambientales –CSAH se utilizó como herramienta para solucionar o mitigar las variaciones de los caudales del río Meléndez, ocasionadas por el deterioro de la cobertura boscosa en la parte alta y media de la cuenca. El objetivo del estudio fue desarrollar una fórmula para definir el valor a compensar a los propietarios y poseedores de zonas de interés, en función de los atributos y características ambientales de los predios. Mediante la aplicación de una fórmula matemática se determinó el valor a compensar por los servicios ambientales por hectárea, a partir de la estimación de un precio base y en función de las condiciones ideales de los predios, para garantizar la regulación hídrica: a) presencia de quebradas, b) existencia de franja de protección, c) presencia de fuentes de agua, d) condiciones del suelo, e) sistemas productivos. El valor a compensar por año se encuentra entre un mínimo de $367.748 y un máximo de $735.496 (precios de 2015), que equivale al costo de oportunidad estimado en función de los cuatro principales cultivos en la parte alta y media de la cuenca. Estos resultados enfatizan la viabilidad de hacer de la compensación por servicios ambientales, un ejercicio que garantice la conservación de las cuencas que abastecen de agua a la población, aguas abajo. Para citar este artículo Salazar, A. (2015). Diseño de un esquema de compensación por servicios ambientales para la cuenca del río Meléndez en el Municipio de Santiago de Cali, Colombia. Rev. Colomb. Investig. Agroindustriales, 2(1), 25-40. DOI: http://dx.doi.org/10.23850/24220582.167

Las oportunidades de interacción y cruce entre nuestras redes viales y ríos son muy frecuentes, siendo los puentes los que ayudan al transporte. Cabe indicar también que los puentes fallan principalmente por problemas hidráulicos según las estadísticas mundiales, sin embargo la necesidad de minimizar estas fallas ha llevado a desarrollar una gran cantidad de investigaciones. Además la aplicabilidad de todas estas investigaciones se resumen en fórmulas y metodologías para determinar la socavación total en pilares, quedando un vacío para los proyectistas e ingenieros el criterio correspondiente a que fórmula o metodología emplear. Es por eso que el propósito de la presente investigación es aplicar un análisis comparativo de los métodos basados en la superposición de componentes de socavación para pilares complejos a un caso específico y real como lo es el puente Reque, pues esta estructura al interactuar con el río provoca la obstrucción al flujo produciendo en sus bases de fundación (pilares, placa de fundación y pilotes), un aumento gradual de la socavación y por ende provocar fallas en la estructura.

Aim: Caudal epidural anesthesia has been shown to reduce stress response and shorten the time to extubation in children after cardiac surgery. Combined with general anesthesia, regional anesthesia has been proven to be safe and efficacious in the pediatric population. It is not known, however, whether the use of caudal anesthesia actually reduces postoperative pain scores and decreases postoperative opioid use. Methods: We retrospectively analyzed the charts of 199 children who underwent repair for atrial septal defect (ASD), ventricular septal defect (VSD), and Tetralogy of Fallot (TOF) at a major academic children's hospital between 2010 and 2013. Results: Eighty-six patients underwent preoperative placement of caudal anesthesia (bupivacaine 0.25% 1 ml·kg-1 up to 20 ml + clonidine 2mcg·kg-1 + Duramorph 40 mcg·kg-1 up to 2.5 mg) and 113 patients did not have a caudal block. Postoperative cardiac intensive care pain scores were analyzed according to standard nurse-recorded patient-appropriate pain scales ranging from 0 to 10 (CRIES for neonates and FLACC for 2 months–7 years). There was no statistical difference between caudal and noncaudal groups with respect to postoperative pain scores or with postoperative opioid requirements. There was a statistical significance with regard to intraoperative opioid use as noncaudal patients invariably received more opioid during the procedure. Conclusion: Although regional anesthesia reduced intraoperative opioid usage, there was no difference in postoperative opioid usage or pain scores. [ABSTRACT FROM AUTHOR]

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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]

Background: Surgical correction of vesicoureteric reflux through ureteric reimplantation is a common, highly successful treatment. Postoperative pain can be severe and may relate to somatic wound pain from the lower abdominal incision or from visceral bladder spasm pain. Aim: To conduct a prospective quality improvement audit to compare four perioperative analgesic techniques. Methods: Observational data were collected on 217 patients following open ureteroneocystostomy over 5 days. The patients were split into four groups: (i) 'morphine' infusion; (ii) 'caudal'--single-shot caudal; (iii) 'epidural'-- epidural catheter inserted at T10-L2 given a bolus, followed by an infusion of 0.125% bupivacaine with fentanyl 2 lg ml -1; (iv) 'caudal catheter'--caudal placed epidural catheter was treated similar to the epidural catheter. Data regarding postoperative analgesic interventions were recorded. Intravesical pethidine was used for bladder spasm pain and i.v. morphine for wound pain. Results: Over the study period, the caudal catheter technique (mean interventions/ patient = 1.8 ± 2.6) and the single-shot caudal (6.1 ± 4) needed significantly less bladder spasm interventions than morphine (9.2 ± 4) and epidural (8.0 ± 4.4) patients. For wound pain, the caudal catheter (8.8 ± 3.3) and epidural groups (11.4 ± 3.2) needed significantly less interventions than morphine (16.1 ± 3) and caudal (15.3 ± 3.3) patients. Overall, caudal catheter patients on average required about half the number of pain interventions and were associated with less high nursing workload. Conclusions: Despite some limitations in data collection and study design, the caudal catheter technique was superior at reducing pain interventions, particularly bladder spasm interventions. Overall epidural analgesia was not superior to a single-shot caudal followed by opioid infusion. The issue of bladder spasm may be similar to the phenomenon of sacral sparing in obstetric epidural anesthesia. Thus, regional techniques, such as caudal epidural, targeting a better balance between sacral and lumber nerves are required. [ABSTRACT FROM AUTHOR]

This paper presents the results obtained using a mathematical model, to simulate different situations plugging on issuers irrigation systems micoirrigación in the cultivation of guava in two subunits irrigation the UBPC the Tezón in Ciego de Avila province. The model is that the uniformity of the emitter flow is affected by the hydraulic factor, manufacturing and plugging. For the preparation of the experimental data obtained with the implementation of these procedures has been developed a computational tool using an Excel 2007 worksheet that allows quickly and with a wide margin of safety obtain fundamental results of these calculations. The aim of this work is to simulate seals issuers using mathematical modeling in micro irrigation systems. [ABSTRACT FROM AUTHOR]

Context: Caudal analgesia is a reliable and an easy method to provide intraoperative and postoperative analgesia for infraumbilical surgeries in pediatric population but with the disadvantage of short duration of action after single injection. Many additives were used in combination with local anesthetics in the caudal block to prolong the postoperative analgesia. Aim: We compared the analgesic effects and side effects of dexmedetomidine added to ropivacaine in pediatric patients undergoing lower abdominal surgeries. Settings and Design: Double-blinded randomized controlled trial. Materials and Methods: Sixty patients (2-10 years) were evenly and randomly assigned into two groups in a double-blinded manner. After sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.25% (1 ml/kg) combined with either dexmedetomidine 2 µg/kg in normal saline 0.5 ml, or corresponding volume of normal saline according to group assignment. Hemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, requirement of additional analgesic, sedation, and side effects were assessed during the first 24 h. Results: The duration of postoperative analgesia was significantly longer (P = 0.001) and total consumption of rescue analgesic was significantly lower in Group RD compared with Group R (P < 0.05). Group RD have better quality of sleep and prolonged duration of sedation (P = 0.001). No significant difference was observed in the incidence of hemodynamic changes or side effects. Conclusion: Addition of dexmedetomidine to caudal ropivacaine significantly prolongs analgesia in children undergoing lower abdominal surgeries without an increase in the incidence of side effects. [ABSTRACT FROM AUTHOR]

Study Objective: We conducted this study to compare the efficacy of caudal epidural block (CEB) vs ultrasonography-guided transversus abdominis plane (TAP) block for providing postoperative pain relief in children scheduled for lower abdominal surgery. Whereas the primary objective was to compare the duration of postoperative analgesia, the secondary objectives included comparative assessment (TAP vs CEB) of quality of pain relief in the first 24hours postoperatively and rescue analgesia requirements.Design: Randomized-control, prospective, observer-blinded, 2-arm, single-center comparison.Setting: Operating room, postoperative recovery area.Patients: Eighty-children, aged 2-6years, of American Society of Anesthesiologists physical status I/II scheduled to undergo unilateral lower abdominal surgery under general anesthesia.Interventions: The recruited children were randomly allocated to receive under general anesthesia either CEB (group C, 0.75 mL/kg of 0.25% bupivacaine) or ultrasonography-guided administration of TAP block (group T, 0.5 mL/kg of 0.25% bupivacaine).Measurements: Intraoperative: heart rate and noninvasive blood pressure; postoperative: pain profile, including duration of postoperative analgesia, quality of pain relief, and rescue analgesia requirements.Main Results: The median duration of postoperative analgesia was significantly greater in children who received CEB than those who were administered TAP block (group C: 362.5 minutes [172.5-693.75] vs group T: 210 minutes [108.75-362.5]; P<.05). No difference was found in the incidence of postoperative pain up to 6 hours from the point of initiation of assessment (group C: 47.2% vs group T: 55.9%; P>.05). The children who received CEB experienced greater incidence of pain in the 6- to 24-hour postoperative interval than those administered TAP block (group C: 75% vs group T: 44.1%; P<.05). Although there was no difference in the rescue analgesia requirements, the number of children not requiring any rescue analgesia in the first 24 hours postoperatively was significantly higher in the TAP group (group C: n=2 vs group T: n=8; P<.05).Conclusions: In children undergoing lower abdominal surgery, CEB provides a significantly prolonged duration of postoperative analgesia when compared with ultrasonography-guided TAP block. [ABSTRACT FROM AUTHOR]

Background: Caudal block is a reliable regional analgesic technique for pediatric urogenital surgeries. Various adjuvants have been tried to enhance the duration of action of bupivicaine. Though clonidine is extensively used as an adjuvant in caudal anaesthesia, it can have troublesome adverse effects like bradycardia, hypotension and sedation. Lately dexamethasone has become popular as an adjuvant in paediatric caudals due to its safety profile. Aim: The aim of this study was to compare dexamethasone and clonidine coadministered with bupivicaine caudally in paediatric patients undergoing urogenital surgeries in terms of analgesia and adverse effects. Settings and Design: Prospective, double blinded randomised study. Subjects and Method: Sixty American Society of Anesthesiologists physical status I and II children, aged 1-6 years undergoing urogenital surgeries were allocated in 2 groups: Group I: 0.5 mL.kg-1 of 0.25% bupivicaine with dexamethasone 0.1 mg.kg-1 in 1 ml normal saline (NS) Group II: 0.5 mL.kg-1 of 0.25% bupivicaine with clonidine 1 µg.kg-1 diluted in 1 ml normal saline. The parameters studied included duration of analgesia, intraoperative and postoperative hemodynamics, sedation scores and incidence of adverse effects like wound dehiscence, bleeding, vomiting and respiratory depression. Statistical Analysis Used: Statistical analysis was carried out using Stata Version 10. After checking for the normality assumption, t-test for comparing means of two independent samples was used for comparing baseline continuous variables. P values <0.05 were considered significant. Results: Patients in Group II had longer duration of analgesia postoperatively. Patients in this group also had lower heart rate and more sedation scores. Conclusion: Our study shows that caudal dexamethasone is a good alternative to clonidine with more stable hemodynamics and lesser sedation scores in the immediate postoperative period. Both the drugs offer good analgesia postoperatively with the duration of analgesia more in clonidine. [ABSTRACT FROM AUTHOR]

In short-germ arthropods, posterior segments are added sequentially from a segment addition zone (SAZ) during embryogenesis. Studies in spiders such as Parasteatoda tepidariorum have provided insights into the gene regulatory network (GRN) underlying segment addition, and revealed that Wnt8 is required for dynamic Delta (Dl) expression associated with the formation of new segments. However, it remains unclear how these pathways interact during SAZ formation and segment addition. Here, we show that Delta-Notch signalling is required for Wnt8 expression in posterior SAZ cells, but represses the expression of this Wnt gene in anterior SAZ cells. We also found that these two signalling pathways are required for the expression of the spider orthologues of even-skipped (eve) and runt-1 (run-1), at least in part via caudal (cad). Moreover, it appears that dynamic expression of eve in this spider does not require a feedback loop with run-1, as is found in the pair-rule circuit of the beetle Tribolium. Taken together, our results suggest that the development of posterior segments in Parasteatoda is directed by dynamic interactions between Wnt8 and Delta-Notch signalling that are read out by cad, which is necessary but probably not sufficient to regulate the expression of eve and run-1. Our study therefore provides new insights towards better understanding the evolution and developmental regulation of segmentation in other arthropods, including insects. [ABSTRACT FROM AUTHOR]

Study Design: Prospective study OBJECTIVE.: The aim of this study was to evaluate variations in the sacral hiatus based on ultrasonographic images.Summary Of Background Data: Caudal epidural injection is commonly used for the treatment of lower back pain, but blind injections commonly lead to mistakes made at the injection site due to anatomic variations in the sacral hiatus.Methods: A total of 339 patients with low back pain or sciatica were studied using a linear-array ultrasound transducer. The transducer was placed at the sacral cornua and the distance between the bilateral cornua and the width of the sacrococcygeal ligament between the bilateral cornua were measured in the transverse view. The transducer was also placed between the two cornua and the distance between the skin and posterior sacral bony surface was measured, including the depth of the subcutaneous fat, in the longitudinal view. The surface distance was then measured from the natal cleft to the apex of the sacral hiatus.Results: The mean distance between the bilateral cornua was 18.1 ± 3.2 mm and mean width of the sacrococcygeal ligament was 10.5 ± 2.6 mm. The mean diameter of the sacral canal was 6.8 ± 2.5 mm but 6 of 339 patients (1.8%) found less than 2 mm. The mean surface distance from the natal cleft to the apex of the sacral hiatus was 29.3 ± 12.3 mm. The distance between the sacral hiatus and the natal cleft ranged from -2.0 to 75.0 mm.Conclusion: We believe that the variations found in the surface distance from the natal cleft to the sacral hiatus are significant for caudal epidural injection. However, the other measurements may also have clinical importance in this area.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background and Aims: Caudal block (CB) with adjuvants is routinely used in children for anaesthesia. We evaluated the efficacy of the α2 adrenergic agonist, dexmedetomidine at two different doses as an adjuvant to bupivacaine in CB. Methods: This study was conducted on ninety children. Control group BD0 received 0.25% bupivacaine 1 ml/kg, whereas, the study groups BD1 and BD2 received 1 μg/kg and 2 μg/kg dexmedetomidine, respectively, with 0.25% bupivacaine 1 ml/kg as a single shot CB. Adequacy of the block, haemodynamic changes, duration of analgesia and side effects were compared. Analysis of Variance was used for between-group comparisons of numerical variables. Student's t-test and Mann-Whitney U-test were used for quantitative data. Results: The demography was comparable. Anal sphincter 5 min after administration of the CB was relaxed in 89.3%, 82.1% and 75% of cases in BD0, BD1 and BD2 groups, respectively. The sphincter was relaxed at the end of surgery in all the cases. Comparable haemodynamics was noted with significantly prolonged duration of analgesia in the groups BD1 (964.2 ± 309 min) and BD2 (1152.6 ± 380.4 min) compared to control (444.6 ± 179.4 min). While no complications were encountered in groups BD0 and BD1, bradycardia was observed in four cases of BD2 group with accompanied hypotension in one of them. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine improves the quality of CB, provides good operating conditions and increases the duration of post-operative analgesia. We conclude that 1 μg/kg is as effective as 2 µg/kg of dexmedetomidine and with a better safety profile. [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]

Orexin neurons in the lateral hypothalamus (LH) play an important role in arousal, guaranteeing the execution of medial prefrontal cortex (mPFC)-related higher cognitive functions. The mPFC is anatomically and functionally a rostro-caudal hierarchy. Little is known about the innervation pattern, especially in the rostro-caudal model, from the arousal-promoting orexin system in the LH to the mPFC subregions, including the anterior cingulate cortex (AC), prelimbic cortex (PL) and infralimbic cortex (IL). Here, we used an anterograde tracing method and immunohistochemistry and found that the density of the LH, as well as orexinergic, fibers increased from the rostral part to the caudal part of the mPFC, regardless of AC, PL or IL. Similarly, the distribution of type 1 orexin receptors in the mPFC follows a rostro-caudal increasing gradient hierarchy. These data suggest a rostro-caudal hierarchy of LH orexinergic innervation to the mPFC. We hope to provide anatomical and morphological evidence for the regulation pattern of the arousal-promoting orexin system on the cognition-related mPFC system. [ABSTRACT FROM AUTHOR]

Background and Aims: Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM), and to find out the incidence of side effects. Material and Methods: This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 µg/kg, group II 50 µg/kg, and group III 70 µg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted. Results: The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting. Conclusion: CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind. [ABSTRACT FROM AUTHOR]

Background: The study was conducted to evaluate the perioperative analgesic efficacy of the two doses of caudally administered tramadol versus bupivacaine in adult hemorrhoidectomy. Patients and Methods: A total of 90 patients, aged 20-50 years, undergoing hemorrhoidectomy were randomly scheduled to receive bupivacaine 0.25% in 20 ml (Group B; n = 30), tramadol 1 mg/kg in 20 ml (Group T1; n = 30), tramadol 2 mg/kg in 20 ml (Group T2; n = 30) through caudal route after induction of general anesthesia. Postoperative pain was assessed every hour until the visual analog scale was 6, which is 1st time for rescue analgesia. Postoperative sedation, hemodynamic changes, serum cortisol, and epinephrine levels and incidence of side effects were also evaluated. Results: Duration of analgesia was longer in Group T2 (20 [1.14] h] compared with the Group B (7 [1.2] h) or Group T1 (12 [0.75] h); all P < 0.001. There were no significant hemodynamic changes. There were not incidences of side effects. Conclusion: Caudal tramadol 2 mg/kg provided a longer duration of postoperative analgesia with rapid onset and no incidence of complications or adverse effects in adult hemorrhoidectomy. [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]

In wireless sensor networks applications, events occur occasionally; therefore, the design of protocols has been focused on saving energy mainly. As consequence of this protocol design strategy most of these energy-efficient protocols limit the use of wireless sensor networks to those applications where a fast response time and the bandwidth are not important. This paper proposes the LEMR-multichannel protocol (Latency, Energy, MAC and Routing, for its acronym in English). LEMR-multichannel is a communication protocol based on a multilayer design which involves the physical, medium access and network layer, which not only preserves the energy efficiency of current protocols but also coordinates the transfer of packets from source to destination in such a way that the network performance in terms of bandwidth, delay and jitter is improved significantly. The LEMR-multichannel superiority in terms of these variables is shown when it is compared with other well-known protocols (TMAC and YMAC), through several simulation experiments. [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]

The basin of the Tecka-Gualjaina River is located in the northwest of the Chubut Province, extended over an area of 5,318 km2. The paper explores the influence of the atmosphere-ocean system on the interannual streamflow variability for the season of maximum streamflow (from June to November), which represents 80% of the annual streamflow, and of minimum streamflow (from December to May). The Hydric balance yielded dryness conditions, for which the temporal behavior of the streamflow depends on precipitation. The maximum streamflow series showed negative trend in the full available record 1956-2013, with a change in the regime of streamflow anomalies by the beginning of the 80s, evolving from a positive predominance before to a negative one after. The minimum streamflow series was more stationary, without significant trend. The dominant cycles in both time series are only observed in the interannual high frequency (~ 2 years and ~ 4-5 years). Teleconnections and forcing associated to the streamflow time series were analyzed in the period 1979-2013 using ERA-Interim reanalysis. The year-to-year variations of maximum streamflow time series were associated with low frequency (interannual) tropospheric teleconnection, symmetric about the equator, possibly associated with variations of tropical convection between about 10° N-10° S and 150° E -180° E, induced by variations of sea surface temperature in the equatorial western Pacific (180° W-150° W). The teleconnection affected the position and intensity of the subtropical and polar jets, altering the trajectory of winter baroclinic systems that precipitate in the region. The year-to-year variations of maximum streamflow time series were associated with a high latitude annular mode-like variability, modulated by a wave-3 train at mid-latitudes over the South Pacific and South Atlantic. These features might have favored dynamic changes in the extratropical moisture transport leading to changes in precipitation towards the mid-west and southern Patagonia, affecting the Tecka-Gualjaina River basin. The results showed that at least between 1979 and 2013, the Tecka-Gualjaina River streamflow variability had tropic-extratropical teleconnections as a main forcing, associated with variations in the warming of sea surface temperatures of the equatorial central Pacific, being partly due to ENSO activity. [ABSTRACT FROM AUTHOR]

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