RT Book, Section
A1 Butterworth IV, John F.
A1 Mackey, David C.
A1 Wasnick, John D.
SR Print(0)
ID 1161433618
T1 Nutrition in Perioperative & Critical Care
T2 Morgan & Mikhail's Clinical Anesthesiology, 6e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259834424
LK accessmedicine.mhmedical.com/content.aspx?aid=1161433618
RD 2024/04/19
AB KEY  CONCEPTS  The  fit,  previously  well-nourished  patient  undergoing  elective  surgery  could  be  fasted  for  up  to  a  week  postoperatively  without  apparent  adverse  effect  on  outcomes,  provided  that  fluid  and  electrolyte  needs  are  met.  On  the  other  hand,  it  is  well  established  in  multiple  studies  that  malnourished  patients  benefit  from  nutritional  repletion  via  either  enteral  or  parenteral  routes  prior  to  surgery.  The  indications  for  total  parenteral  nutrition  (TPN)  are  narrow,  including  those  patients  who  cannot  absorb  enteral  solutions  (small  bowel  obstruction,  short  gut  syndrome,  etc);  partial  parenteral  nutrition  may  be  indicated  to  supplement  enteral  nutrition  (EN)  when  EN  cannot  fully  provide  for  nutritional  needs.  TPN  will  generally  require  a  venous  access  line  with  its  catheter  tip  in  the  superior  vena  cava.  The  line  or  port  through  which  the  TPN  solution  will  be  infused  should  be  dedicated  to  this  purpose,  if  at  all  possible,  and  strict  aseptic  techniques  should  be  employed  for  insertion  and  care  of  the  catheter.  In  the  patient  with  critical  illness,  discontinuing  an  EN  infusion  may  require  multiple  potentially  dangerous  adjustments  in  insulin  infusions  and  maintenance  of  intravenous  fluid  rates.  Meanwhile,  the  evidence  is  sparse  that  EN  infusions  delivered  through  an  appropriately  sited  gastrointestinal  feeding  tube  increases  the  risk  of  aspiration  pneumonitis.  Regardless  of  whether  the  TPN  infusion  is  continued,  reduced,  replaced  with  10%  dextrose,  or  stopped,  blood  glucose  monitoring  will  be  needed  during  all  but  short,  minor  surgical  procedures.