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.

Uso de la Dexmedetomidina en la Neurocirugía con el paciente despierto. A propósito de un caso clínico / Use of Dexmedetomidine in Neurosurgery with the patient awake. About a clinical case

Presentamos el caso de un paciente de 58 años, coordinado para resección de tumor temporo insular izquierdo mediante una craneotomía despierto. Se analiza en este trabajo, a partir de la descripción del caso clínico, las ventajas de la resección de este tipo de lesiones con el paciente despierto. La posibilidades de abordaje, despierto durante todo el procedimiento (awake), dormido-despierto-dormido (asleep-awake-asleep), dormido-despierto (asleep-awake). A su vez se analiza la técnica anestésica, la combinación de fármacos y especialmente las características de la Dexmedetomidina. Conclusiones: la neurocirugía con el paciente despierto, determina una serie de características y desafíos para el equipo anestésico tratante y la interacción con un equipo mulitidisciplinario (neurocirujanos, neurofisiologos, anestesiologos). Existen diferentes combinaciones de fármacos; siendo la Dexmedetomidina una opción que mejorar la satisfacción de los pacientes durante la etapa de despertar, así como las condiciones quirúrgicas con mínimas interferencia en la monitorización neurofisiológica.

We present the case of a 58-year-old patient, scheduled to resection of left insular tumor by an awake craniotomy. In this paper, from the description of the clinical case, we analyzed the advantages of a resection of this type of lesion with an awake patient. We discuss the surgical approach, and options of an awake patient all throughout the procedure, asleep-awake-asleep and asleep-awake. Also, the anesthetic technique, the combination of drugs and especially the characteristics of Dexmedetomidine are analyzed. Conclusions: neurosurgery with an awake patient, determines a series of characteristics and challenges for the anesthetic and multidisciplinary team (neurosurgeons, neurophysiologists, anesthesiologists). There are different combinations of drugs, with Dexmedetomidine being an option that would improve patient satisfaction during the awakening stage, as well as surgical conditions with minimal interference in neurophysiological monitoring.

Manejo anestésico en una paciente portadora de estenosis aórtica crítica sometida a cesárea de urgencia. Reporte de un caso clínico / Anesthetic management in a patient with critical aortic stenosis emergency cesarean section. Report of a case

Presentamos el caso de una paciente de 42 años, portadora de válvula mecánica mitral y aórtica, que cursando el tercer trimestre de gestación sufre una disfunción crítica de la prótesis aórtica. Es asistida por el servicio de anestesiología del Hospitalde Clínicas, en este contexto para realizar una cesárea de urgencia. Se analiza en este trabajo el manejo anestesiológico de la gestante con una estenosis aórtica severa por trombosis valvular, sometida a una cirugía cesárea de urgencia. Se realiza una revisión que contempla la técnica anestésica a realizar comparando la anestesia regional versus anestesia general; consideraciones en las técnicas de bloqueo central en pacientes en tratamiento con antifibrinolíticos y antiacoagulantes; monitorización a realizar; relevancia del ecocardiograma transtorácico en el perioperatorio, como otro monitor fundamental para evaluar estado hemodinámico de la paciente; elección de drogas anestésicas que nos brindan mayor seguridad en este tipo de pacientes, con la menor repercusión sobre el feto y su evolución post operatoria. Conclusiones: El manejo anestesiológico de gestantes portadoras de estenosis aórtica crítica sometida a cirugía cesárea es un desafío. La creación de un equipo multidisciplinario, la posibilidad de contar con la monitorización adecuada, y el uso de fármacos que permiten mantener la hemodinamia materna con escasa repercusión sobre el feto permitieron llegar a un resultado exitoso en este caso...