Abbreviation of the period of preoperative fasting and administration of a carbohydrate beverage diminishes insulin resistance and the organic response to trauma.

Espessura do músculo adutor do polegar: um método rápido e Espessura do músculo adutor do polegar: um método rápido e Espessura do músculo adutor do polegar: um método rápido e Espessura do músculo adutor do polegar: um método rápido e Espessura do músculo adutor do polegar: um método rápido e confiável na avaliação nutricional de pacientes cirúrgicos confiável na avaliação nutricional de pacientes cirúrgicos confiável na avaliação nutricional de pacientes cirúrgicos confiável na avaliação nutricional de pacientes cirúrgicos confiável na avaliação nutricional de pacientes cirúrgicos Adductor pollicis muscle thickness: a fast and reliable method for nutritional Adductor pollicis muscle thickness: a fast and reliable method for nutritional Adductor pollicis muscle thickness: a fast and reliable method for nutritional Adductor pollicis muscle thickness: a fast and reliable method for nutritional Adductor pollicis muscle thickness: a fast and reliable method for nutritional assessment in surgical patients assessment in surgical patients assessment in surgical patients assessment in surgical patients assessment in surgical patients ROSALIA Objetivo: Objetivo: Determinar se a medida da espessura do músculo adutor do polegar é confiável para avaliação nutricional de pacientes cirúrgicos e se correlaciona bem com outros parâmetros antropométricos, bioquímicos e clínicos. Métodos:Métodos: Métodos: Métodos: Métodos: Estudo de corte transversal, com avaliação de 87 pacientes candidatos à procedimento cirúrgico de grande porte no trato gastrointestinal. Eles foram submetidos à avaliação nutricional através da avaliação subjetiva global, antropometria (circunferência do braço, prega cutânea triciptal, e circunferência muscular do braço), albumina sérica, linfocitometria e pela medida da espessura do músculo adutor do polegar em ambas as mãos. Resultados:Resultados: Resultados: Resultados: Resultados: A média da espessura da mão dominante (direita) foi de 12,64 ± 3,19 mm e da mão não dominante 12,23 ± 2,9 mm. Para desnutrição, a sensibilidade da espessura do músculo adutor do polegar direita foi de 72,37% e da esquerda de 77,33% para os pontos de cortes encontrados com a curva Receiver Operating Characteristic (13,4 e 13,1 mm respectivamente). Para ambas as mãos a especificidade foi de 100%. Encontrou-se correlação significativa (p<0,01) da espessura do músculo adutor do polegar com todas as outras técnicas antropométricas de avaliação nutricional. Os seus valores médios nos pacientes eutróficos segundo a avaliação subjetiva global foram significativamente maiores (P<0.001) que dos desnutridos leves, e estes também maiores (P<0,05) que os desnutridos graves (avaliação subjetiva global-C). Conclusão:Conclusão: Conclusão: Conclusão: Conclusão: a espessura do músculo adutor do polegar é um método de fácil execução, baixo custo, confiável e transmite segurança na avaliação do estado nutricional, podendo ser usado na prática clínica em pacientes cirúrgicos. 4 . Diante da reconhecida influência do estado nutricional sobre a evolu...

BackgroundProlonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.MethodsSeventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation. Blood samples were collected before surgery and 24 hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and the C-reactive protein (CRP)/albumin ratio. A 5% level for significance was established.ResultsThere were no anesthetic or postoperative complications. The post-operative IR was lower in the CHO-P group when compared with the CO group (2.75 ± 0.72 vs 5.74 ± 1.16; p = 0.03). There was no difference between the two groups in relation to the PINI. The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio (p < 0.05). The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater (p < 0.05) in the CHO-P group (87.5%) than in the CO group (33.3%).ConclusionsShortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations.Trial registrationClinicalTrail.gov NCT01354249

Preoperative intake of a GLN-enriched CHO beverage appears to improve IR and antioxidant defenses and decreases the inflammatory response after video-cholecystectomy.

Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits related to this shorter preoperative fasting include the reduction of postoperative gastrointestinal discomfort and insulin resistance. New formulas containing amino acids such as glutamine and other peptides are being studied and are promising candidates to be used to reduce preoperative fasting time.

BackgroundProlonged fasting increases organic response to trauma. This multicenter study investigated the gap between the prescribed and the actual preoperative fasting times in Brazilian hospitals and factors associated with this gap.MethodsPatients (18–90-years-old) who underwent elective operations between August 2011 and September 2012 were included in the study. The actual and prescribed times for fasting were collected and correlated with sex, age, surgical disease (malignancies or benign disease), operation type, American Society of Anesthesiologists score, type of hospital (public or private), and nutritional status.ResultsA total of 3,715 patients (58.1% females) with a median age of 49 (18–94) years from 16 Brazilian hospitals entered the study. The median (range) preoperative fasting time was 12 (2–216) hours, and fasting time was longer (P<0.001) in hospitals using a traditional fasting protocol (13 [6–216] hours) than in others that had adopted new guidelines (8 [2–48] hours). Almost 80% (n=2,962) of the patients were operated on after 8 or more hours of fasting and 46.2% (n=1,718) after more than 12 hours. Prolonged fasting was not associated with physical score, age, sex, type of surgery, or type of hospital. Patients operated on due to a benign disease had an extended duration of preoperative fasting.ConclusionActual preoperative fasting time is significantly longer than prescribed fasting time in Brazilian hospitals. Most of these hospitals still adopt traditional rather than modern fasting guidelines. All patients are at risk of long periods of fasting, especially those in hospitals that follow traditional practices.

The abbreviation of preoperative fasting time to 3 h using a solution containing carbohydrates and hydrolyzed pea proteins reduces the acute-phase inflammatory response and decreases the postoperative length of stay in patients undergoing major surgery for a malignancy.

Objective: to present recommendations based on the ACERTO Project (Acceleration of Total Post-Operative Recovery) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures. Methods: review of relevant literature from 2006 to 2016, based on a search conducted in the main databases, with the purpose of answering guiding questions previously formulated by specialists, within each theme of this guideline. We preferably used randomized controlled trials, systematic reviews and meta-analyzes but also selected some cohort studies. We contextualized each recommendation-guiding question to determine the quality of the evidence and the strength of this recommendation (GRADE). This material was sent to authors using an open online questionnaire. After receiving the answers, we formalized the consensus for each recommendation of this guideline. Results: the level of evidence and the degree of recommendation for each item is presented in text form, followed by a summary of the evidence found. Conclusion: this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons, the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery. The prescription of these recommendations can accelerate the postoperative recovery of patients submitted to elective general surgery, with decrease in morbidity, length of stay and rehospitalization, and consequently, of costs.