Background:The purpose of this study was to measure the pressure in the anal canal during caudal epidural anesthesia. Methods:The pressure in the anal canal was measured via side-opening perfused catheter in 10 adult patients. The pressure under resting condition was recorded before and following the injection of 10 ml of 1.5% mepivacaine into the caudal epidural space. The pressure when anus was contracted at will was also meassured before and at 5min and 10min after injection. Results: After completion of the injection of mepivacaine, the pressure was gradually decreased. At 4min, the mean resting pressure was significantly decreased to 70% (p< 0.05). The voluntary contractive pressures at 5min and 10min were also significantly decreased to 65% and 51%, respectively (p<0.05). Conclusions:Decrease of pressure in the anal canal appeared surely and early. Pressure in the anal canal can be an effective indicator of the effect of caudal epidural anesthesia.

eterization and for daily care. The catheter was left in place for 1 month, and disinfection was performed almost every day. The pain was reduced considerably (50% on the visual analogue scale) as a result of continuous epidural block with 50 ml of 0.5% bupivacaine and 200 µg of fentanyl per day, as well as oral administration of trazodone hydrochloride.One month after hospitalization, the patient suffered a sudden onset of high fever (39.4°C). There was no evidence of redness or tenderness at the epidural block site, no back pain, and no neurological signs. However, the epidural catheter was removed and Staphylococcus aureus was identified in the culture from the specimen sampled from the catheter tip. Oral romefloxasone (400 mg·day Ϫ1 ) given for 5 days reduced the fever. Two weeks later, a high temperature of 39.3°C recurred, accompanied by headache and neck stiffness. C-reactive protein (CRP) had increased to 15.4 mg·dl Ϫ1 , and the erythrocyte sedimentation rate (ESR) was 124 mm·h Ϫ1 . S. aureus was also detected by blood culture. The cerebrospinal fluid (CSF) had a high white blood cell count (4800 · mm Ϫ3 ), but CSF culture showed no bacterial growth. Magnetic resonance imaging (MRI) indicated a low signal intensity at the T4 and T5 vertebral bodies on T1-weighted images and a slightly low signal intensity on T2-weighted images, so that spondylitis was suspected.Although intravenous imipenem (1 g·day Ϫ1 ) reduced the fever, back pain, and neck stiffness, the ESR remained at 100 mm·h Ϫ1 . There were no other neurological signs. Right leg paralysis and bilateral hypesthesia below the T9 level occurred abruptly 15 days after the second episode of high fever. MRI revealed a mass that was compressing the spinal cord at the T4-5 level and was enhanced by gadolinium on T1-weighted images (Fig. 1), so that an epidural abscess was suspected. Extensive spinal cord edema was seen on T2-weighted images (Fig. 2). These examination results led to a diagnosis of pyogenic spondylitis at T4 and T5 accompanied

consulted an obstetrician, who was unable to find any abnormalities. As the lumbar pain worsened in the evening and her face lost color, the patient was brought to our hospital by ambulance.On physical examination, she was conscious, but her face looked pale and the palpebral conjunctiva was anemic. She was sweating profusely. Her blood pressure was 62/20 mmHg and her heart rate was 120 bpm. However, no genital bleeding was found. Blood examination showed a hemoglobin level of 6.4 g·dl Ϫ1 and a total protein level of 3.4 g·dl Ϫ1 . Chest X-ray showed no sign of intrathoracic bleeding. Abdominal echography performed by an obstetrician showed no evidence of obstetric bleeding, such as abruptio placentae. Because the fetal heart rate decreased to 40 bpm, an emergency cesarean section was performed without further investigation of the cause of the hemorrhagic shock.On arrival at the operating room, her blood pressure was 60/10 mmHg and her heart rate was 125 bpm. Anesthesia was induced with ketamine 60 mg, and succinylcholine 90 mg was used to facilitate tracheal intubation. Anesthesia was maintained with sevoflulane (0.5%-1.0%) in 40% oxygen and 60% nitrous oxide using mechanical ventilation. Blood gas analysis revealed severe acidosis, with pH 6.98, PaCO 2 33 mmHg, PaO 2 212 mmHg, base excess (BE) Ϫ20.2 mmol·l Ϫ1 , and HCO 3Ϫ 7.8 mmol·l Ϫ1 . The hematocrit was below 15%. Three minutes after incision, a neonate was delivered. The Apgar score was zero at 1 and 5 min. The neonate could not be resuscitated. There were no abnormalities in the uterus and intraperitoneum. A huge hematoma, however, was found in the retroperitoneum, which was caused by a ruptured aneurysm in the left common iliac artery. For about 30 min, until the abdominal aorta was clamped, the systolic blood pressure remained around 40 mmHg. The blood pressure increased to 80-120 mmHg after the aorta was clamped. An artificial vessel replacement was performed. The

No abstract

Headache classification committee of the international headache society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 8 (Suppl. 7): 1•`96, 1988