Early oral nutrition after elective colorectal surgery: influence of balanced analgesia and enforced mobilization

Henriksen, Michala de Linde; Hansen, H. V.; Hessov, I

doi:10.1016/s0899-9007(01)00749-3

Cited by 63 publications

(30 citation statements)

References 21 publications

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“…By postoperative day 30, the patients had lost a mean of 3.3 kg (1.2 kg LBM) corresponding to 4.6% of the preoperative weight. In previous studies of similar patients, we have found mean weight losses of 2-3 kg or around 5% (Jensen & Hessov, 1997b;Henriksen et al, 2002b) and other institutions have typically reported losses of 3-5 kg following uncomplicated abdominal surgery (Ulander et al, 1998) However, 27 of 81 (33%) patients had weight losses exceeding 4 kg. We did not find that mean preoperative weight or LBM was regained after 3 months, in fact the weight was significantly reduced by 1.2 kg and any preoperative weight loss has to be added to that.…”

Section: Discussionmentioning

confidence: 57%

“…In previous studies on patients undergoing colorectal surgery (Jensen et al, 1998;Henriksen et al, 2002b), we have also found that the patients preoperatively generally had normal BMI's and only had small preoperative weight losses-approximately 1.7 kg (Jensen & Hessov, 1997b). By postoperative day 30, the patients had lost a mean of 3.3 kg (1.2 kg LBM) corresponding to 4.6% of the preoperative weight.…”

Section: Discussionmentioning

confidence: 63%

“…Concomitantly they will be less physically active and have a reduction in physical performance (Jensen & Hessov, 1997a;Henriksen et al, 2002a). Following uncomplicated surgery, patients will increase their nutritional intake during the first postoperative days (Henriksen et al, 2002b) and the body mass and physical performance will be at the premorbid level within months to a year in most patients (Hill et al, 1993;Henriksen et al, 2002a).…”

Section: Introductionmentioning

confidence: 99%

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Little effect of physical training on body composition and nutritional intake following colorectal surgery—a randomised placebo-controlled trial

et al. 2005

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Objective: Postoperatively patients have a reduction in nutritional intake and body weight. We studied the effect of postoperative physical training on nutritional intake and body composition. Methods: Patients X60 y admitted for elective colorectal surgery were randomised to train muscular strength (group A) or to nonstrengthening exercises (group B) for 3 months. Fat mass (FM) and lean body mass (LBM) were assessed with bioimpedance preoperatively, 7, 30, and 90 days postoperatively. Nutritional intake was registered in a subpopulation. Results: Of 119 included patients, 60 were randomised to group A and 59 to B. The changes in LBM at postoperative day 7 were a mean (s.d.) of 0.4 (2.1) kg in group A compared to À0.7 (2.0) kg in B. The difference between groups of 1.2 (0.5) kg at day 7 was statistically significant (P ¼ 0.03). At no other time was observed difference between groups in weight, LBM, or FM. The energy and protein intake rose during postoperative day 1-7 and rose further after discharge. At no time were differences between groups. Conclusion: Physical training had little effect on body composition following abdominal surgery. The nutritional intake in wellnourished patients did not increase by training.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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Little effect of physical training on body composition and nutritional intake following colorectal surgery—a randomised placebo-controlled trial

et al. 2005

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“…This has been observed in almost all studies across the world. Early ambulation promotes a sense of well being and has also been shown to predict early discharge and return to productivity [20]. Early enteral nutrition was accepted by majority of the patients in the FTS group.…”

Section: Discussionmentioning

confidence: 93%

Fast-Tracking Colostomy Closures

Nanavati

Prabhakar

2015

Indian J Surg

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There have been very few studies on applying fasttrack principles to colostomy closures. We believe that outcome may be significantly improved with multimodal interventions in the peri-operative care of patients undergoing this procedure. A retrospective study was carried out comparing patients who had undergone colostomy closures by the fasttrack and traditional care protocols at our centre. We intended to analyse peri-operative period and recovery in colostomy closures to confirm that fast-track surgery principles improved outcomes. Twenty-six patients in the fast-track arm and 24 patients in the traditional care arm had undergone colostomy closures. Both groups were comparable in terms of their baseline parameters. Patients in the fast-track group were ambulatory and accepted oral feeding earlier. There was a significant reduction in the duration of stay (4.73±1.43 days vs. 7.21± 1.38 days, p=0.0000). We did not observe a rise in complications or 30-day re-admissions. Fast-track surgery can safely be applied to colostomy closures. It shows earlier ambulation and reduction in length of hospital stay.

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“…Alterações do sistema nervoso autônomo, de neurotransmissores, de fatores inflamatórios locais e da resposta metabólica/inflamatória assim como, a presença de diferentes hormônios, a anestesia e a analgesia pós-operatória têm sido descritos como fatores causais. De sorte que uma abordagem multivariada deve ser usada para minimizar ou tratar a disfunção fisiológica da motilidade após procedimentos cirúrgicos 8,[44][45][46][47] . A oferta de nutrição precoce é uma dessas variáveis que deve ser associada à anestesia epidural, cirurgia minimamente invasiva, medicações antieméticas, mobilização precoce no pós-operatório e preparo psicológico do paciente, entre outras (Tabela 1).…”

Section: Correia Et Alunclassified

Paradigmas e evidências da nutrição peri-operatória

Correia

Silva

2005

Rev. Col. Bras. Cir.

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Conflito de interesse: nenhum Fonte de financiamento: nenhuma Trabalho realizado no Instituto Alfa de Gastroenterologia do Hospital das Clínicas da UFMG. IntroduçãoA abordagem nutricional de pacientes cirúrgicos é aspecto fundamental no cuidado dos mesmos. Múltiplos estudos randomizados, meta-análises e revisões têm abordado o tema. No entanto, alguns aspectos ainda continuam a ser alvo de inúmeras controvérsias, especialmente no tocante ao período adequado de jejum pré-operatório e à liberação da dieta no pós-operatório. Esses aspectos envolvem alguns dos paradigmas existentes em Medicina, mais propriamente em Cirurgia, que geram, por sua vez, angústia e medo aos profissionais envolvidos no tratamento de pacientes operados.Operações eletivas são, em geral, realizadas após 10 a 16 horas de jejum. A rotina é manter-se o paciente sem comer desde a noite anterior ao ato operatório. Esse período é tido como fundamental para que no momento da indução anestésica o estômago esteja completamente vazio e o risco de aspiração seja mínimo. No entanto, esse tempo é suficientemente longo do ponto de vista metabólico, levando a depleção do estoque de glicogênio, o que tem impacto na resposta orgânica ao estresse, além de gerar desconforto a vários pacientes 1 ,2 . A resposta orgânica apresenta-se aumentada em pacientes submetidos a jejum noturno, quando comparada a pacientes que receberam infusão de carboidratos 1,2 . Logo, o jejum pré-operatório aumenta o estresse metabólico induzido pelo tratamento cirúrgico.A liberação da dieta no pós-operatório é outro ponto controverso que tem gerado inúmeras discussões. Em geral, os cirurgiões aguardam a resolução do chamado íleo pós-operatório, ou seja, eliminação de flatos ou evacuação, para a liberação da dieta. Isso ocorre por volta do terceiro ou quarto dia pós-operatório. Além disso, a tradição cirúrgica orienta a oferta escalonada ou progressiva da dieta líquida, pastosa até à sólida. Essa prática não só pode contribuir com a piora do estado nutricional de pacientes previamente desnutridos, como aumenta o tempo de internação hospitalar 3 . Por outro lado, pacientes submetidos a grandes intervenções e alimentados precocemente apresentam melhor oxigenação da mucosa intestinal 4 , diminuição da resposta orgânica e do número de complicações no pós-operatório 5 -7 , assim como redução do tempo de dismotilidade intestinal 8,9 . É nosso objetivo nesta revisão abordar o impacto do jejum pré-operatório e da nutrição precoce no pós-operatório, do ponto de vista metabólico e da associação com complicações, tempo de internação, custos e conforto do paciente. Assim sendo, paradigmas que até hoje são a rotina cirúrgica pré e pós-operatória serão, seguramente, colocados em questionamento. Jejum pré e pós operatório versus resposta orgânica ao estresseA necessidade de jejum prolongado, desde a noite que antecede a operação, tem sido questionada e, novas condutas têm sido adotadas [10][11][12] . Na verdade, essa prática foi iniciada, quando as técnicas anestésicas ainda eram rudimentares o que au...

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Early oral nutrition after elective colorectal surgery: influence of balanced analgesia and enforced mobilization

Cited by 63 publications

References 21 publications

Little effect of physical training on body composition and nutritional intake following colorectal surgery—a randomised placebo-controlled trial

Little effect of physical training on body composition and nutritional intake following colorectal surgery—a randomised placebo-controlled trial

Fast-Tracking Colostomy Closures

Paradigmas e evidências da nutrição peri-operatória

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