Our greater understanding of gastric physiology and the epidemiology of Mendelson's syndrome has allowed the traditional guidelines for preoperative fasting (nothing by mouth after midnight or 6 hours before surgery) to be changed, based on the results of many scientific studies. The stomach is not emptied of liquids and solids in the same way, and therefore preoperative fasting should not be the same for both. Human milk leaves the stomach more rapidly than infant formulas, and the emptying of non-human milk is similar to that of solids. Fasting does not guarantee that the stomach will be empty or that the pH of gastric juices will be high; moreover, shortening the preoperative fasting period may bring several advantages for the patient. Factors such as premedication, anxiety, age, certain associated diseases or injuries may or may not influence gastric emptying and/or acidity at the time of anesthesia. We review the literature, including the guidelines on fasting of the American Society of Anesthesiologists for application with healthy patients of all ages in elective procedures, excluding, among others, women in childbirth and patients undergoing emergency surgery.

Adult↗

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[Tetanus in a drug addict and HIV carrier patient].

We report the resuscitation of a woman with a severe tetanic process, dependence on drugs and acquired immunodeficiency syndrome. During her course, the patient presented high hemodynamic lability and supraventricular and ventricular ectopic beats. Impairment of oxygenation and ventilation led to tracheotomy and controlled ventilation for 25 days. Then, intermittent mandatory ventilation was initiated and maintained for 15 days. The patient was extubated. Partial pressure of oxygen in the arterial blood was 73 mmHg and PaO2/FIO2 was 183; she had a sepsis of pulmonary origin. High doses of sedative and analgesic agents (diazepam, 40 mg/hour and morphine, 2.5 mg/hour) were required. We believe the acme of the process was on days 13 and 15 during her stay at the resuscitation unit. We conclude that neither the symptomatology nor her course nor the treatment differed from other severe forms of tetanus treated by us. The infective process did not fit into what would be expected in an immunodeficient background.

Adult↗

PubMedDate not supplied

[Security in the specialty].

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Anesthesiology↗

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[Correlation between the concentration of plasma lactic acid and other cardiorespiratory parameters in hypoxic patients].

We carried out a study in a group of 20 patients; this group was made up of 16 women and 4 men. All patients were under controlled ventilation and the relation between partial pressure of oxygen and the fraction of oxygen to be inhaled was equal or less than 150. A Swan-Ganz catheter was implanted in the pulmonary artery and another catheter in a radial artery. We determined the cardiac output, oxygen saturation in mixed venous blood and blood levels of lactic acid. We calculated the oxygen supply, oxygen consumption and tissue extraction of oxygen. We could to point out that there is a positive and significative correlation between lactic acid blood levels and cardiac output, oxygen consumption and oxygen extraction (p less than 0.001); negative and significative between acid blood levels and oxygen supply (p less than 0.025) and oxygen saturation in mixed venous blood (p less than 0.001). Finally we observed that when the lactic acid blood levels went up, decrease in oxygen saturation in mixed venous blood is more acute that increase in cardiac output.

Adult↗

PubMedDate not supplied

[Prevalence of HIV antibody carriers in patients assisted in the recovery room].

A study has been performed on 200 patients at the Recovery Department of our hospital during 1987. This study was carried out in order to determine patients with human immunodeficiency virus (HIV) antibody. This group was randomized and consisted of 154 men and 46 women, with an average age of 35.6 +/- 3.9, a total weight of 68 +/- 6 kg and a height of 1.69 +/- 0.2 m. The day entered at the Recovery Department we assessed the following parameters: a) addiction to drugs by parenteral way; b) bleeding; c) invasive procedures; d) etiology, and e) blood samples were drawn for plasma antibody to HIV. We detected five patients (2.5%) with antibody anti-HIV and all of these patients were male and they were aged in 20-39 years old. We noticed a close relation between addiction to drugs and HIV (p less than 0.001), nevertheless no relation has been found between invasive procedures, bleeding, etiology and antibody to HIV. We conclude that the number of patients that we detected with antibody from the HIV is similar to those found by other studies that has been carried out in emergency situation, but greater than those found in the screening of the general population.

Acquired Immunodeficiency Syndrome↗

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