Pearls and Pitfalls
Manage well-nourished elective patients according to “stress-free” Enhanced Recovery After Surgery (ERAS) principles with optimal pain relief, pro-active management of gut function and early mobilization.
Allow oral fluids until 2 h prior to operation to decrease dehydration, and consider routine pre-operative oral carbohydrate and fluid loading to promote post-operative anabolism.
Employ thoracic epidural anesthesia to reduce sympathetic activation, prevent paralytic ileus, control pain on movement, and promote mobilization.
Recommence feeding early in the post-operative period. If voluntary nutritional intake is inadequate, supplement with artificial nutritional support.
Use enteral nutrition in preference to parenteral nutrition in patients with functioning gastrointestinal (GI) tracts.
Commence early oral/enteral nutritional support in all malnourished surgical patients to reduce the effects of the stress response and prevent post-operative complications.
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Skipworth, R.J.E., Fearon, K.C.H. (2009). Nutritional Support in the Surgical Patient. In: Bland, K.I., Büchler, M.W., Csendes, A., Sarr, M.G., Garden, O.J., Wong, J. (eds) General Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-833-3_3
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