Anesthesiology
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Comparative Study
Ultrasound evaluation of the sacral area and comparison of sacral interspinous and hiatal approach for caudal block in children.
Although caudal block via the sacral hiatus is a common regional technique in children, it is sometimes difficult to identify the hiatus. A needle approach via the S2-3 interspace can be used as an alternative to the conventional approach. The authors compared the feasibility and clinical characteristics between the S2-3 approach and hiatal approach, in addition to ultrasound study. ⋯ The S2-3 approach can be applied as a useful fallback method to the conventional landmark approach in children, especially in those older than 36 months who present with difficult identification of the sacral hiatus.
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Perioperative beta-blockade and anemia are independent predictors of increased stroke and mortality by undefined mechanisms. This study investigated the effect of beta-blockade on cerebral tissue oxygen delivery in an experimental model of blood loss and fluid resuscitation (hemodilution). ⋯ Cerebral tissue oxygen tension is preferentially maintained during hemodilution, relative to the kidney, despite elevated systemic catecholamines. Acute beta-blockade impaired the compensatory cardiac output response to hemodilution, resulting in a reduction in cerebral tissue oxygen tension and increased expression of HIF-1alpha.
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Comment Letter
Are signposts in the woods pointing in the right direction?