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Enhanced recovery after surgery (ERAS) protocols termed as “fast track surgery” have now become an essential componentin the perioperative period to improve post-operative outcomes. It is both the patient and the health services who receive thebenefits of ERAS. It is a new and different approach when compared to traditional practices which aims at enhanced care ofsurgical patients. It includes pre-operative, intraoperative, and post-operative components which when applied altogether givebest possible results. Effective implementation of ERAS protocols is associated with fast recovery of gut function and reducedrate of complications. All these factors further lead to decreased post-operative hospital stay, thereby decreasing hospital costand increasing patient satisfaction.
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Background:Malnutrition is a high-risk co-morbidity in acute hip fracture patients. Pre-operative carbohydrate loading may improve nutritional status and therefore patient outcomes. The feasibility of nutrition focused randomised control trial designs in hip fractureis at best questionable. This study was designed to undertake efficacy testing of pre-operative carbohydrate loading and explore the broader feasibility of conducting randomised controlled trials in acute hip fracture.Methods:This two arm randomised controlledfeasibility study recruited patients previously living in the community who had fractured their hip undergoing surgery at our institution. Patients in the intervention arm received a 400mL (50g) carbohydrate load 2hours prior to surgery. Information was collected regarding the fidelity of pre-operative carbohydrate provision and consumption as well as patient demographic and admission details.Results:Thirty-two patients consented to participate, 60% of the eligible patient cohort. Results demonstrated evenly matched intervention and control groups in terms of demographic details and pre-surgical morbidity and mortality risk. However, of the 17 patientsallocated to the intervention arm less than half (41%) completed the carbohydrate loading intervention and even fewer 23.5% (n=4) completed all follow up due to a number of patient and system related factors. Conclusions: Evaluating the clinical effectiveness of providing pre-operative carbohydrate loading in hip fracture and the associated outcomes is not feasible using a randomised control trial methodology. It is recommended that researchers consider a ̳silver standard‘ of research and practice such aspragmatic, registry-based cluster randomised trials to ensure feasibility, relevancy and applicability when evaluating nutritional interventions in this cohort
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The enhanced recovery after surgery (ERAS) program aims to maximize the recovery of patients by minimizing pre- and postoperative complications and stress. The program recommends providing preoperative carbohydrate (CHO) supplements and starting an early postoperative diet to reduce the fasting duration. Based on these recommendations, we implemented preoperative CHO supplementation and initiated an early postoperative diet in patients undergoing laparoscopic colorectal resection. We observed 3 patients as follows: a non-ERAS case, preoperative ERAS case, and pre- and postoperative ERAS case. The preoperative well-being and compliance of patients improved after implementation of the ERAS program. Moreover, the length of hospital stay was reduced. Therefore, we consider that the ERAS program may be helpful for the recovery of patients undergoing laparoscopic colorectal resection.
Subject(s)
Humans , Colorectal Surgery , Compliance , Diet , Fasting , Feeding Behavior , Length of Stay , Postoperative ComplicationsABSTRACT
The trauma involved in any surgical procedure, even if elective, causes a metabolic stress response characterized by postoperative insulin resistance (PIR). PIR is considered a surgical stress marker and is associated with increased morbidity and postoperative length of stay. PIR worsens when the patient is operated in a state of prolonged preoperative fasting or when postoperative feeding is delayed. The ERAS Protocols (Enhanced Recovery After Surgery) includes anesthetic, surgical, kinesiology, nutritional and nursing interventions aimed to modulate PIR. The nutritional perioperative interventions in the ERAS protocols, focus on avoiding prolonged preoperative fasting by oral carbohydrate loading up to two hours before surgery, accompanied by early postoperative feeding through the digestive tube. These nutritional perioperative interventions are safe and effective to reduce complications and postoperative stay, even in patients with well controlled type 2 diabetes. Nevertheless, their implementation and compliance are rather low, therefore, we must continue to make efforts in order to change perioperative nutritional management of our patients to achieve the best possible postoperative recovery.
Subject(s)
Humans , Clinical Protocols , Perioperative Care/methods , Nutrition Therapy/methods , Postoperative Complications/prevention & control , Nutrition AssessmentABSTRACT
Overnight fasting before elective surgery has been the routine to reduce the risk of pulmonary aspiration. Recently, several international guidelines for preoperative fasting recommend to intake carbohydrate-containing fluids up to 2 to 3 hours before the induction of anesthesia to improve postoperative recovery. Based on the recommendations, we developed a "preoperative carbohydrate diet" provided for the preoperative patients. The purpose of this case report is to share our experience of applying preoperative carbohydrate loading prior to surgery.
Subject(s)
Humans , Anesthesia , Fasting , Insulin Resistance , PancreaticoduodenectomyABSTRACT
Objective To explore the effect of combination application of preoperative carbohydrate loading and sequential enteral nutrition on the recovery of postoperative patients with stomach neoplasm.Methods Ninety-eight patients with stomach neoplasm were randomly divided into three groups.Those were Group A (preoperative fasting + sequential EN,n =33),group B (preoperative carbohydrate loading + postoperative TPN,n =33) and group C (preoperative carbohydrate loading + sequential EN,n =32).Insulin sensitivity (IS) ; Nutritional indicators including pre-albumin (PA) and transferrin (TRF) ; immunity parameters including IgG,IgM and IgA were measured in blood on the day before the operation,the 1st day,4th day and 8th day after the operation.Meanwhile,anal exhaust time after the operation,incidence of complications and postoperative hospitalizing time were also observed.Results The level of IS in group C at 4th day and 8th day after operation were 35.8 ± 3.2 and 36.1 ± 3.5,higher than those in A group and B group (A group:30.7 ±3.3,33.5 ±2.9;B group:33.7 ±3.1,34.0 ±2.2),and the differences were significant((F =20.88,7.28 ;P ＜0.05).At the 4th day after the operation,the levels of PA in group B and group C were (191 ± 11.6) mg/ and (193 ± 12.7) mg/L,significantly higher than those in group A ((176 ± 14.1) mg/L;F =17.15,P ＜ 0.01).At the 8th day after the operation,the levels of PA and TRF in group C were (221.3 ±30.81) mg/L and (86 ± 0.37) g/L,significantly higher than those in group A and group B (group A:(198.0 ± 30.6) mg/L,(1.60 ± ±0.33) g/L;group B:(202.0 ±28.6) mg/L,(1.61 ±0.34) g/L;F =5.42,5.83 ;P ＜0.01).At the 8th day after the operation,the levels of IgA,IgG and IgM in the group C were (2.74 ±0.69) g/L,(14.55 ±2.57) g/ L,(1.08 ± 0.33) g/L,significantly higher than that in group A and group B (group A:(2.30 ± 0.54) g/L,(12.71 ±2.94) g/L,(0.86 ±0.31) g/L;group B:(2.29 ±0.50) g/L,(12.06 ±3.33) g/L,(0.89 ±0.27)g/L;F =6.12,6.13,4.94;P ＜ 0.05).Conclusion The combination of preoperative carbohydrate loading and sequential enteral nutrition can reduce insulin resistance,improve postoperative nutritional status,improve the recovery of immune function and intestinal function,as well as reduce the incidence of postoperative complications.
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Objective: To explore the clinical significance of combination preoperative carbohydrate loading and postoperative enteral nutrition in patients with gastric cancer during perioperative period. Methods: 70 patients were randomly divided into group A(preoperative fasting + postoperative EN,n = 23),group B(preoperative carbohydrate loading + postoperative TPN,n = 23) and group C(preoperative carbohydrate loading + postoperative EN,n = 20).After operation,insulin sensitivity,nutritional status,immune function and clinical outcome were compared among three groups. Results: Compared with the other two groups in insulin sensitivity,nutritional status,immune function and clinical outcome,the group C was better and different(P
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This study was undertaken to examine whether carbohydrate loading gives a good effect to improve the endurance performance in Japanese subjects who had habitually eaten carbohydrate-rich diets. The glycogen content of the vastus lateralis muscle was determined in 6 healthy male subjects with the aid of the needle biopsy technique by setting different diets after glycogen store was depleted by exhaustive exercise.<BR>Glycogen content of the vastus lateralis muscle after mix, low and high carbohydrate diets was 22.7±2.0, 11.6±1.6 and 36.6±4.5 g/wet muscle⋅kg (mean±SD), respectively, while exhaustive time was 75′39″±10′02″, 67′58″±14′11″and 92′10″±22′10″ (mean±SD), respectively. Thus, a good correlation was noted between muscle glycogen content and work time.<BR>It was therefore concluded that the glycogen content of the working muscle was a determinant factor for the capacity to perform long-term heavy exercise and that carbohy-drate loading attained with low carbohydrate diet and exhaustive exercise followed by high carbohydrate diet had a good effect to perform heavy exercise even in Japanese who lived on carbohydrate-rich diet.