RESUMEN
PURPOSES: The objective of this study was to evaluate the effect of supplementation with vitamin C on intestinal anastomosis healing in malnourished rats. METHODS: Male Wistar rats were divided into three groups: (1) sham, well-nourished rats that received vehicle; (2) FR+Veh, rats that were subjected to food restriction and received vehicle; and (3) FR+VC, rats that were subjected to food restriction and received vitamin C. Four days before surgery, the animals received vitamin C (100 mg/kg/day) via gavage and underwent colon resection with anastomosis in a single plane. The survival rate of rats was monitored until day 7 after surgery. Regarding anastomosis tissues, we examined intra-abdominal adhesion index, hydroxyproline content, collagen density, inflammatory parameters, and oxidative damage to proteins and lipids. RESULTS: Malnutrition decreases body weight and increases mortality; the survival rate was 90 % in group 1, 60 % in group 2, and 80 % in group 3. Vitamin C was able to increase hydroxyproline concentration and density of collagen and decrease the intra-abdominal adhesion index, as well as the infiltration of neutrophils and oxidative damage to proteins in malnourished rats compared to group treated with vehicle. CONCLUSIONS: Preoperative vitamin C supplementation can improve the intestinal anastomosis healing, biochemical alterations, and prolong survival in rats subjected to food restriction.
Asunto(s)
Ácido Ascórbico/uso terapéutico , Colon/cirugía , Suplementos Dietéticos , Desnutrición/tratamiento farmacológico , Cuidados Preoperatorios , Recto/cirugía , Cicatrización de Heridas/efectos de los fármacos , Anastomosis Quirúrgica , Animales , Ácido Ascórbico/administración & dosificación , Ácido Ascórbico/farmacología , Peso Corporal/efectos de los fármacos , Colágeno/metabolismo , Colon/efectos de los fármacos , Colon/patología , Hidroxiprolina/metabolismo , Masculino , Desnutrición/complicaciones , Nitratos/metabolismo , Nitritos/metabolismo , Estrés Oxidativo/efectos de los fármacos , Peroxidasa/metabolismo , Ratas Wistar , Recto/efectos de los fármacos , Recto/patología , Adherencias Tisulares/complicaciones , Adherencias Tisulares/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
OBJECTIVE: To evaluate the results of the introduction of new measures to accelerate the postoperative recovery of patients undergoing elective abdominal surgery. METHODS: We observed 162 patients and interviewed them on two distinct periods: the first between October to December 2009 (n = 81) comprised patients who underwent conventional perioperative monitoring (pre-intervention) and the second between March and May 2010 (n = 81), formed by a new group of patients, submitted to the new protocol of perioperative monitoring. Data collection in the two periods occurred without the knowledge of the professionals in the service. The variables were: indication for preoperative nutritional support, duration of fasting, post-operative volume of hydration, use of catheters and drains, length of stay and postoperative morbidity. RESULTS: when comparing the two periods we observed a decrease of 2.5 hours in the time of preoperative fasting (p = 0.0002) in the post-intervention group. As for the reintroduction of oral diet, there was no difference between the two periods (p = 0.0007). When considering the patients without postoperative complications, there was a significantly decreased length of stay (p = 0.001325). There was a reduction of approximately 50% in antibiotic use in the post-intervention group (p = 0.00001). CONCLUSION: The adoption of multidisciplinary perioperative measures is feasible within our reality, and although there was no statistically significant changes in the present study, it may improve morbidity and reduce length of stay in general surgery.
Asunto(s)
Abdomen/cirugía , Procedimientos Quirúrgicos Electivos/normas , Atención Perioperativa/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJETIVO: Avaliar os resultados da introdução de novas medidas visando acelerar a recuperação pós-operatória de pacientes submetidos à cirurgia abdominal eletiva. MÉTODOS: Foram observados e entrevistados 162 pacientes e entrevistados durante dois períodos distintos: o primeiro, entre outubro a dezembro de 2009 (n=81) formado por pacientes submetidos à condutas convencionais de acompanhamento peri-operatório (período pré-intervenção) e o segundo, entre março a maio de 2010 (n=81), formado por um novo grupo de pacientes submetidos, então, ao novo protocolo de condutas de acompanhamento peri-operatório. A coleta de dados nos dois períodos ocorreu sem o conhecimento dos profissionais do serviço. As variáveis observadas foram: indicação de suporte nutricional pré-operatório; tempo de jejum pré e pós-operatório; volume de hidratação; uso de sondas e drenos; tempo de internação e morbidade pós-operatória. RESULTADOS: Na comparação entre os dois períodos, observou-se no período pós-intervenção uma diminuição de 2,5 horas no tempo de jejum pré-operatório (p=0,0002). Em relação à reintrodução da dieta por via oral houve diferença entre os dois períodos (p=0,0007). Considerando os pacientes que não apresentaram complicações no pós-operatório houve diminuição significativa no tempo de internação (p=0,001325). Houve uma redução de aproximadamente 50% no uso de antibiótico no período pós-intervenção (p=0,00001). CONCLUSÃO: A adoção de medidas multidisciplinares peri-operatórias é exequível dentro da nossa realidade e embora não tenha havido alterações com significância estatística no presente estudo, pode melhorar a morbidade e diminuir tempo de internação em cirurgia geral de modo significante.
OBJECTIVE: To evaluate the results of the introduction of new measures to accelerate the postoperative recovery of patients undergoing elective abdominal surgery. METHODS: We observed 162 patients and interviewed them on two distinct periods: the first between October to December 2009 (n = 81) comprised patients who underwent conventional perioperative monitoring (pre-intervention) and the second between March and May 2010 (n = 81), formed by a new group of patients, submitted to the new protocol of perioperative monitoring. Data collection in the two periods occurred without the knowledge of the professionals in the service. The variables were: indication for preoperative nutritional support, duration of fasting, post-operative volume of hydration, use of catheters and drains, length of stay and postoperative morbidity. RESULTS: when comparing the two periods we observed a decrease of 2.5 hours in the time of preoperative fasting (p = 0.0002) in the post-intervention group. As for the reintroduction of oral diet, there was no difference between the two periods (p = 0.0007). When considering the patients without postoperative complications, there was a significantly decreased length of stay (p = 0.001325). There was a reduction of approximately 50% in antibiotic use in the post-intervention group (p = 0.00001). CONCLUSION: The adoption of multidisciplinary perioperative measures is feasible within our reality, and although there was no statistically significant changes in the present study, it may improve morbidity and reduce length of stay in general surgery.