Preoperative fasting for the infusion of "yerba mate": a randomized clinical trial with ultrasound evaluation of gastric contents

Abstract Background The traditional infusion of "yerba mate" is widely consumed in South America and exported to countries around the world. Although generally considered a "clear fluid", there is no data to date on the gastric emptying time of yerba mate and safe preoperative fasting intervals. The objective of this study was to evaluate the gastric emptying time of a standardized infusion of yerba mate using bedside ultrasound and compare it with the time confirm of hot and cold tea. Methods This was a prospective, randomized crossover experimental study. Thirty healthy volunteers were evaluated after 8 hours of fasting for both fluids and solids. Gastric antral area and gastric volume were evaluated at baseline and every 20 minutes after drinking 300 mL of randomly assigned infusion of "yerba mate", hot tea, or cold tea. Results The mean gastric emptying time was: 69.7 ± 22.1 min, 63.1 ± 14.5 min, and 64.3 ± 23.5 min for the mate, hot tea, and cold tea respectively. No significant differences were found in emptying time among the infusion groups (p-value = 0.043). When same time measures were compared, the only significant difference detected was between hot teas and mate infusion at 20 minutes (p-value = 0.012) Conclusion Yerba mate infusion has a similar gastric emptying time to that of tea. All subject's gastric volume returned to baseline values by 100 minutes. It is reasonable to recommend a similar fasting period of 2 hours for mate infusion prior to elective surgery.

Preoperative fasting for the infusion of "yerba mate": a randomized clinical trial with ultrasound evaluation of gastric contents.

BACKGROUND: The traditional infusion of "yerba mate" is widely consumed in South America and exported to countries around the world. Although generally considered a "clear fluid", there is no data to date on the gastric emptying time of yerba mate and safe preoperative fasting intervals. The objective of this study was to evaluate the gastric emptying time of a standardized infusion of yerba mate using bedside ultrasound and compare it with the time confirm of hot and cold tea. METHODS: This was a prospective, randomized crossover experimental study. Thirty healthy volunteers were evaluated after 8 hours of fasting for both fluids and solids. Gastric antral area and gastric volume were evaluated at baseline and every 20 minutes after drinking 300 mL of randomly assigned infusion of "yerba mate", hot tea, or cold tea. RESULTS: The mean gastric emptying time was: 69.7 ± 22.1 min, 63.1 ± 14.5 min, and 64.3 ± 23.5 min for the mate, hot tea, and cold tea respectively. No significant differences were found in emptying time among the infusion groups (p-value = 0.043). When same time measures were compared, the only significant difference detected was between hot teas and mate infusion at 20 minutes (p-value = 0.012) CONCLUSION: Yerba mate infusion has a similar gastric emptying time to that of tea. All subject's gastric volume returned to baseline values by 100 minutes. It is reasonable to recommend a similar fasting period of 2 hours for mate infusion prior to elective surgery.

Cirugía con despertar operatorio para procesos expansivos cerebrales. Reporte de 20 casos

Resumen: Introducción: La cirugía de lesiones expansivas cerebrales con paciente despierto es una técnica que se usa de forma cada vez más frecuente. Esto se debe a que es una técnica costo efectiva para realizar resección de tumores cerebrales de forma amplia y segura. Resultado: Se presentan 20 pacientes operados con dicha técnica. Se trató de 13 hombres y 7 mujeres, rango etario 16 - 67 años, portadores de 17 lesiones tumorales y 3 lesiones vasculares (angiomas cavernosos). Se realizaron 22 cirugías ya que dos pacientes se intervinieron 2 veces. Se logró resección supra-máxima en 3 casos, completa en 9, subtotal en 5 y parcial en 2 pacientes. Un paciente no se pudo operar debido a que presentó un despertar inadecuado y el procedimiento se suspendió. En cuanto a las complicaciones, 18% de los pacientes presentaron crisis intra-operatorias, pero las mismas no impidieron el desarrolló del procedimiento con normalidad luego de yugulada la crisis. Dos pacientes (9% de los procedimientos) presentaron un despertar inadecuado. En un caso la lesión se resecó completamente de todas formas, en el otro se suspendió el procedimiento. 18% de los pacientes presentaron una peoría funcional transitoria y un 4.5% presentó una peoría definitiva (paresia severa). Un solo paciente (4.5%) presentó una infección del colgajo que requirió retiro de la plaqueta ósea y colocación de una placa de acrílico en diferido. Conclusiones: Las cifras presentadas por los autores están en concordancia con las de los centros regionales e internacionales de referencia.

Abstract: Introduction: Expansive brain injury surgery with awake patients is a technique that is being used more and more frequently. This is because it is a cost-effective technique for performing brain tumor resection widely and safely. Outcome: Twenty patients operated with this technique are presented. There were 13 men and 7 women, age range 16 - 67 years, carriers of 17 tumor lesions and 3 vascular lesions (cavernous angiomas). 22 surgeries were performed since two patients underwent surgery twice. Supra-maximal resection was achieved in 3 cases, complete in 9, subtotal in 5, and partial in 2 patients. One patient could not be operated on due to inadequate awakening and the procedure was suspended. Regarding complications, 18% of the patients presented intra-operative seizures, but they did not prevent the normal development of the procedure after the crisis was jugulated. Two patients (9% of the procedures) had inadequate awakening. In one case the lesion was completely resected anyway, in the other the procedure was suspended. 18% of the patients presented a transitory functional deterioration and 4.5% presented a definitive worsening (severe paresis). Only one patient (4.5%) had a flap infection that required removal of the bone plate and placement of a delayed acrylic plate. Conclusions: The figures presented by the authors are in accordance with those of the regional and international reference centers.

Resumo: Introdução: A cirurgia de lesão cerebral extensiva com pacientes acordados é uma técnica cada vez mais utilizada. Isso ocorre porque é uma técnica econômica para realizar a ressecção de tumor cerebral de forma ampla e segura. Resultado: São apresentados 20 pacientes operados com essa técnica. Eram 13 homens e 7 mulheres, com idades entre 16 e 67 anos, portadores de 17 lesões tumorais e 3 lesões vasculares (angiomas cavernosos). Foram realizadas 22 cirurgias, pois dois pacientes foram operados duas vezes. A ressecção supra-máxima foi alcançada em 3 casos, completa em 9, subtotal em 5 e parcial em 2 pacientes. Um paciente não pôde ser operado devido ao despertar inadequado e o procedimento foi suspenso. Em relação às complicações, 18% dos pacientes apresentaram convulsões no intra-operatório, mas não impediram o desenvolvimento normal do procedimento após a jugulação da crise. Dois pacientes (9% dos procedimentos) tiveram despertar inadequado. Em um caso a lesão foi totalmente ressecada de qualquer maneira, no outro o procedimento foi suspenso. 18% dos pacientes apresentaram uma deterioração funcional transitória e 4,5% apresentaram piora definitiva (paresia grave). Apenas um paciente (4,5%) apresentou infecção do retalho que exigiu a retirada da placa óssea e colocação de placa acrílica retardada. Conclusões: Os números apresentados pelos autores estão de acordo com os dos centros de referência regionais e internacionais.

A magnetic resonance imaging study of local anesthetic spread in patients receiving an erector spinae plane block.

PURPOSE: Despite the popularity of the erector spinae plane (ESP) block, both the mechanism of the block and the extent of injectate spread is unclear. This study used magnetic resonance imaging (MRI) to evaluate the spread of local anesthetic injectate following ESP blocks in six patients with pain. METHODS: Six patients received a left-sided ultrasound-guided ESP block at the T10 level. The injectate contained 29.7 mL of 0.25% bupivacaine and 0.3 mL of gadolinium in the first patient, with an additional 5 mL (50 mg) of triamcinolone in the subsequent five patients. Sensory block to pinprick and cold as well as pain score (with 0 indicating no pain and 10 being maximum pain) were assessed 20 and 30 min respectively following the ESP block. MRI was performed one hour after the block. RESULT: The injectate spread into the intercostal space and neural foramina in all six patients, but the extent of cephalocaudal spread was variable, with a median [interquartile range] spread of 9 [5-11] and 3 [2-6] levels for the intercostal space and neural foramina, respectively. The injectate also spread extensively within the erector spinae muscles. Spread to the epidural space was seen in two patients. Sensory block was achieved in both ventral and dorsal dermatomes in all patients, though the extent was variable. CONCLUSIONS: Our study showed that the ESP block injectate consistently spread to the erector spinae muscles, neural foramina, and intercostal space. It was associated with sensory changes and pain relief in the dorsal and ventral thoracic and abdominal walls. Nevertheless, the extent of spread to the neural foramina and intercostal space, and the sensory block itself, was highly variable.

RéSUMé: OBJECTIF: Malgré la popularité du bloc plan des érecteurs du rachis (PER), le mécanisme du bloc et l'ampleur de la diffusion du produit injecté ne sont pas clairement connus. Cette étude a utilisé l'imagerie par résonance magnétique (IRM) pour évaluer la diffusion de l'anesthésique local injecté après des blocs du PER chez six patients présentant des douleurs. MéTHODES: Six patients ont reçu un bloc du PER guidé par échographie du côté gauche au niveau T10. Le produit injecté contenait 29,7 mL de bupivacaïne 0,25 % et 0,3 mL de gadolinium pour le premier patient avec un supplément de 5 mL (50 mg) de triamcinolone pour les cinq patients suivants. Le bloc sensitif au toucher/piquer et au froid, ainsi que le score de douleur (où 0 indique une absence de douleur et 10, une douleur maximum) ont été évalués respectivement 20 et 30 minutes après le bloc du PER. Une IRM a été réalisée une heure après le bloc. RéSULTAT: Le produit injecté a diffusé dans l'espace intercostal et les foramens intervertébraux chez les six patients, mais l'étendue de la diffusion céphalocaudale a été variable avec une diffusion médiane [plage interquartile] de 9 [5 à 11] niveaux pour les espaces intercostaux et 3 [2 à 6] niveaux pour les foramens intervertébraux. Le produit injecté a également largement diffusé dans les muscles érecteurs du rachis. Une diffusion vers l'espace épidural a été observée chez deux patients. Un bloc sensitif des dermatomes ventraux et dorsaux a été obtenu chez tous les patients, bien que son étendue ait été variable. CONCLUSIONS: Notre étude a montré que le produit injecté dans un bloc du PER diffusait constamment dans les muscles érecteurs du rachis, les foramens intervertébraux et les espaces intercostaux. Il a été associé à des modifications sensorielles et à un soulagement de la douleur dans les parois thoraciques et abdominales, ventrales et dorsales. Néanmoins, l'étendue de la diffusion vers les foramens intervertébraux et les espaces intercostaux, ainsi que le bloc sensitif proprement dit ont été très variables.