Topic 17 Nutritional ...

The phenomenon of stress encountered after surgeries is a useful response but if not controlled can lead to auto cannibalism. The counter regulatory hormones and inflammatory response to surgery causes insulin resistance and hyperglycemia which increases complication and mortality in postoperative critically ill patients. Insulin resistance can be reduced by use of anaesthesia and analgesis, asting. as well as preoperative metabolic preparation using carbohydrates instead of overnight fasting. Preoperative loading of carbohydrates has shown to reduce nitrogen losses and retain body mass. Prehabilitation is a new programe in order to condition high risk patients 4-6 weeks before surgery. The more classical nutritional therapy nutritional support has to be considered on individual basis, preoperative enteral or parenteral feeding in malnourished patients for seven to 14 days may be associated with reduction of post operative morbidity. Postoperative ileus is caused by inhibitory sympathetic activity of bowel, mid thoracic epidural analgesia promotes postoperative bowel function by blocking inhibitory reflexes, and also helps avoid the use of opioids that inhibit gut motility. Maintaining postoperative fluid balance is another key factor in preventing postoperative ileus. Malnourished patients are more prone to complication.