Impacto do estado nutricional e do tempo de jejum nas complicações gastrointestinais e no tempo de hospitalização em pacientes cirúrgicos / Impact of the nutritional status and fasting time in gastrointestinal complications and hospitalization time in surgical patients

Introdução: O estado nutricional e o tempo de jejum pré e pós-cirúrgico impactam na morbimortalidade de pacientes submetidos a cirurgias eletivas. No Brasil, o tempo de jejum prolongado e a elevada prevalência de desnutrição são comuns nos hospitais terciários. Objetivo: Realizar levantamento do tempo de jejum médio praticado em hospital terciário e avaliar o impacto do jejum pré e pós-cirúrgico e do estado nutricional nas complicações gastrointestinais imediatas e no tempo de hospitalização em pacientes cirúrgicos. Material e métodos: Estudo prospectivo, realizado no Hospital Universitário Walter Cantídio, em Fortaleza. Foram avaliados 173 indivíduos submetidos a cirurgias eletivas de médio e grande porte entre agosto de 2016 a janeiro de 2017. Foram coletadas medidas antropométricas, hemograma e informações como tempo de jejum pré e pós-cirúrgico, permanência hospitalar e complicações gastrointestinais. As análises de correlação e associação foram realizadas no Software SPSS®, com nível de significância fixado em p< 0,05. Resultados: A maioria dos pacientes (71,1%) foi submetida à cirurgia de porte II (grande porte). Houve correlação negativa entre tempo de permanência hospitalar e índice de massa corporal [r= -0,223; p= 0,003], circunferência braquial [r= -0,335; p< 0,001], dobra cutânea tricipital [r= -0,320; p< 0,001], área muscular do braço corrigida [r= -0,253; p= 0,001], contagem total de linfócitos [r= -0,223; p= 0,008], hemoglobina [r= -0,243; p= 0,004] e relação linfócito/monócito [r= -0,308; p< 0,001]. Adicionalmente, houve correlação positiva entre tempo de permanência hospitalar com o tempo de jejum pós-cirúrgico [r= 0,456; p< 0,001]. Ausência de complicações gastrointestinais foi associada a valores de triagem (Nutritional Risk Screenin-2002) < 3 (p= 0,034) e entre menor tempo de jejum pós-cirúrgico (p= 0,033). Conclusão: Pacientes desnutridos, com maior risco nutricional e os que se submeteram a um tempo de jejum pós-cirúrgico elevado apresentaram maior tempo de permanência hospitalar e maior incidência de complicações gastrointestinais.

Introduction: The nutritional status and pre and postoperative fasting time impact the morbidity and mortality of patients undergo to elective surgeries. In Brazil, prolonged fasting time and high prevalence of malnutrition are common in tertiary hospitals. Objective: To evaluate the mean preoperative and postoperative fasting time and the impact of fasting, and nutritional status on gastrointestinal complications and on length of hospital stay in surgical patients. Material and methods: A prospective study, conducted at Walter Cantídio University Hospital, in Fortaleza. One hundred and seventy three surgery patients were evaluated between August 2016 and January 2017. The subjects were divided in two groups (medium and large size). Anthropometric measurements, blood count and information about pre and postoperative fasting time, hospital stay and gastrointestinal complications data were collected. Correlation and association test were performed by Software SPSS®. P<0.05 was considered significant. Results: The majority of the patients (71,1%) were included in size II (large) surgery. There was a negative correlation between length of stay in hospital and body mass index [r= -0,223; p= 0,003], brachial circumference [r= -0,335; p<0,001], triceps skinfold thickness [r= -0,320; p<0,001], arm muscle area [r= -0,253; p= 0,001], total lymphocyte count [r= -0,223; p= 0,008], hemoglobin [r= -0,243; p= 0,004] and lymphocyte/monocyte ratio [r= -0,308; p<0,001]. In addition, there was a positive correlation between length of stay in hospital and postoperative fasting time [r= 0,456; p<0,001]. Absence of gastrointestinal complications was associated with Nutrition Risk Screening-2002 <3 (p= 0,034) and shorter post-operative fasting time (p= 0,033). Conclusion: Malnourished patients, higher nutritional risk and higher postoperative fasting time were associated to longer hospital stay and a higher incidence of gastrointestinal complications.

Study on shortening the time of initial oral intake after general anesthesia in patients receiving oral and maxillofacial surgery / 中国实用护理杂志

Objective To study the effect of shortening the time of initial oral intake and fluid intake after general anesthesia in patients receiving oral and maxillofacial surgery on promotion of postoperative recovery. Methods A total of 116 patients were divided into the control group and the observation group with 58 cases in each group by random digit table from January 2014 to December 2015. Patients in the control group were allowed to take food orally 6 h after they regain analepsia from anesthesia;while those in the observation group were allowed to drink water after 2 h upon analepsia from anesthesia and take liquid food after 4 h. The mis-aspiration, the fasting glucose, blood pressure, heart rate and the rate of hunger, thirst, nausea, vomiting as well as blood pressure and heart rate were observed. Results The rates of hunger, thirst, nausea, vomiting in the observation group were 17.2%(10/58), 5.2%(3/58), 12.1%(7/58), 1.7%(1/58), which were significantly lower than those in the control group, which were 94.8%(55/58), 91.4%(53/58), 36.2%(21/58), 10.3%(6/58), and there were significant differences(χ2=7.484-54.772, all P<0.05). The fasting plasma glucose level in the observation group [(4.93 ± 0.85)mmol/L] was higher than that in the control group [(4.05 ± 0.51)mmol/L],and there was significant difference(t=-7.152, P<0.05). There were significant differences in blood pressure 3 h and 5 h after operation compared with those of the control group(P<0.05). Conclusions Shortening the time of taking food for patients undergoing oral and maxillofacial surgery can relieve uncomfortable symptoms , prevent hypoglycemia and the hemodynamic disturbance after anesthesia and promote recovery,early postoperative feeding should be suggested on the premise that they are fully awake.

Tempo de jejum dos suínos no manejo pré-abate sobre a perda de peso corporal, o peso do conteúdo estomacal e a incidência de úlcera esofágica-gástrica / Relation of fasting time during pre-slaughter management to weight loss, weight of stomach contents and incidence of gastric ulcer in pigs

O objetivo deste trabalho foi avaliar os efeitos do tempo de jejum (9, 12, 15 e 18 horas) dos animais na granja (TJG) e da posição na carroceria do caminhão (PBO) durante o transporte da granja ao frigorífico sobre: a perda de peso corporal (PPC), o peso do estômago cheio (PEC) e vazio (PEV), o peso do conteúdo estomacal (PCE) e o escore de lesão na mucosa esofágica-gástrica (ELG). Foram utilizadas 192 fêmeas, com peso vivo médio de 134,51±11,80kg. No modelo, foram considerados os efeitos de bloco (estação do ano, BL), TJG, PBO e da interação entre BL x TJG. Verificou-se efeito significativo do TJG apenas sobre o peso do conteúdo estomacal. Não se observou efeito significativo da PBO sobre qualquer das variáveis avaliadas. Dos suínos avaliados, 90,3 por cento apresentaram PEC menor que 500 gramas e 8,56 por cento com PEC entre 500 e 800 gramas. A prevalência de suíno com ELG foi baixa (14,97 por cento), sendo que, dos animais com ELG, 13,90 por cento apresentaram lesão de grau 1 e 1,09 por cento eram grau dois. Conclui-se que animais submetidos a jejum na granja de 15 horas apresentam menor peso do conteúdo estomacal ao abate.

The objective of this study was to evaluate the effect of fasting time period (9, 12, 15 and 18 hours) at the farm (TJG) and the pig's position in the lorry's livestock compartment (PBO) during the transport from the farm to the processing plant on: body weight loss (PPC), weight of stomach (full= PEC and empty= PEV), weight of stomach contents (PCE), and incidence of gastric ulcer (ELG). A total of 192 females with average 34.51±11.80kg of body weigh were used. The statistical model considered the effects of: block (season, BL), TJG, PBO and the interaction between BL and TJG. There was a significant effect of TJG only on stomach content. There was no effect of PBO on any of the evaluated variables. A PEC inferior to 500g was observed in 90.3 percent of the animals, while 8.56 percent of the pigs presented PEC between 500 and 800g. Incidence of ELG was low (14.97 percent), and among the ELG animals, 13.90 percent showed grade 1 lesion, and 1.09 percent grade two lesion. As a conclusion, pigs submitted to a fasting period of 15 hours have less stomach contents at the processing.

Aspiration pneumonitis after a 10-hour fast in a patient who had undergone subtotal gastrectomy: A case report / 대한마취과학회지

A patient who had previously undergone a subtotal gastrectomy was scheduled for removal of a brain tumor under general anesthesia. Anesthesia was induced with lidocaine and propofol with rocuronium for neuromuscular blockade. She had fasted for 10 hours, but after mask ventilation, she aspirated gastric juice and materials. The oral cavity was suctioned promptly and the trachea was intubated. Intraoperative high FiO2 and dopamine were administrated to maintain the oxygen saturation and blood pressure. She received postoperative ventilatory care in the intensive care unit for 2 weeks. An upper gastrointestinal series and fiber endoscopy were performed but she had no obstruction and reflux esophagitis except delayed passage of the contrast media. She had no risk factors for pulmonary aspiration. As in this case, patients with previous gastrointestinal surgery should be considered preoperative workup for GI motility or pathology, and adequate premedication.

Aspiration Pneumonia at Recovery Room in the Patient Emergency Pelviscopic Salpingectomy, without the Perceptive Sign of Gastric Regurgitation during Perioperative Periods: A case report / 대한마취과학회지

Aspiration pneumonia is considered to be a morbid complication of anesthesia, It was reported that several conditions are associated with an increased frequency of aspiration pneumonia, such as gastroenterological, neurological and, pulmonary diseases. The incidence is also higher in emergency situations than during elective surgery. We encountered aspiration pneumonia after emergency laparoscopic salpingectomy. The patient was 25 years old woman with no prior medical history but had fasted for only 5 h in the preoperative period. During the perioperative period, there were no signs of regurgitation of the gastric contents into the oral cavity. After surgery, the patient was transported to the recovery room in a fully awakened state. However, the patient became cyanotic without vomiting. After physiotherapy, a chest CT scan was performed, and she was diagnosed with aspiration pneumonia. She was admitted to intensive care. Ten days later, she was discharged in a healthy state.

A discussion of fasting time of infant patients underwent general anesthesia and nogastrointestlnal tract operations / 中国基层医药

0.05).Con- clusion It is a feasible way for infants to fast in solid diet 6 hours and liquid 2 hours before operation in order to re- duce indisposition of infants and meet the need of operation.