Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Letter Randomized Controlled Trial
Efficacy of a simple scavenging system for long-term critical care sedation using volatile agent-based anesthesia.
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Case Reports
Failed caudal block due to physiologic changes associated with a cerebrospinal fluid leak: a case report.
The sum of the volumes of brain tissue, cerebrospinal fluid (CSF), and intracranial blood remain constant. This tenet of the Monroe-Kellie hypothesis is most often considered in the setting of intracranial hypertension, but it can also be applied in the setting of CSF volume depletion. We used this hypothesis to explain a case of failed caudal block in a patient with an iatrogenic CSF leak. ⋯ The possible mechanism of this failed caudal block was high systemic absorption of anesthetic given the epidural venous plexus engorgement thus leaving less anesthetic acting within the CSF and on the exiting spinal nerves. Decreased CSF flow in the thecal sac might also have contributed, as might dilution of the remaining local anesthetic caused by large amounts of leaking CSF within the epidural space.
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Editorial Comment
Falling after epidural analgesia: lessons from obstetric anesthesia.