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The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

Oral and topical antibiotics are often ineffective in the treatment of erythema and flushing. The most effective way to prevent the occurrence of flushing episodes and the progression of the disease is to avoid the associated trigger factors. Low-dose clonidine (Catapres; mg twice daily) may be effective in controlling flushing, especially in women who are postmenopausal. 18 A nonselective beta blocker (such as long-acting propranolol [Inderal], 80 to 240 mg daily, and nadolol [Corgard], 40 to 80 mg daily) may also be used to treat erythema and flushing. 18

Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.

Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, . He is also an FEI veterinarian and works internationally with the United States Equestrian Team. Ball authored Understanding The Equine Eye , Understanding Basic Horse Care , and Understanding Equine First Aid , published by Eclipse Press and available at or by calling 800/582-5604.

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Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, . He is also an FEI veterinarian and works internationally with the United States Equestrian Team. Ball authored Understanding The Equine Eye , Understanding Basic Horse Care , and Understanding Equine First Aid , published by Eclipse Press and available at or by calling 800/582-5604.

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