Zusammenfassung Fragestellung: Enhanced recovery after surgery (ERAS) Programme sind der Standard im perioperativen Management. Ber?cksichtigt werden muss der nachgewiesene Einfluss einer krankheitsassoziierten Mangelern?hrung auf die postoperative Morbidit?t und Letalit?t. So bed?rfen Patienten mit metabolischem Risiko oder manifester Mangelern?hrung sowie solche Patienten mit postoperativen Komplikationen besonderer ern?hrungsmedizinischer Aufmerksamkeit. Methodik: Die bestehenden Leitlinien der deutschen und europ?ischen ern?hrungsmedizinischen Fachgesellschaften (DGEM, ESPEN) zur enteralen und parenteralen Ern?hrung wurden zusammengef?hrt und in Einklang mit den prozeduralen Vorgaben der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.?V. (AWMF) und des ?rztlichen Zentrums f?r Qualit?t in der Medizin (?ZQ) aktualisiert und erweitert. Ergebnisse: Von der Arbeitsgruppe wurden 41 in der Leitlinienkonferenz konsentierte Empfehlungen zur perioperativen Ern?hrung mit folgender Empfehlungsst?rke erarbeitet: 9-mal A (Empfehlung basiert auf schl?ssiger Literatur guter Qualit?t, die mind. eine randomisierte Studie enth?lt), 12-mal B (Empfehlung basiert auf gut durchgef?hrten, nicht randomisierten Studien), 13-mal C (Empfehlung basiert auf Berichten und Meinungen von Expertenkreisen und/oder klinischen Erfahrungen anerkannter Autorit?ten) und 7-mal KKP (klinischer Konsenspunkt). Schlussfolgerung: Eine perioperative supplementierende k?nstliche Ern?hrung ist auch bei Patienten ohne offensichtliche Mangelern?hrung indiziert, sofern vorhersehbar ist, dass der Patient f?r eine l?ngere postoperative Zeitdauer unf?hig zur ad?quaten oralen Kalorienzufuhr sein wird.

Even in patients without obvious malnutrition perioperative nutritional support is indicated when oral food intake is not feasible or inadequate for a longer period of time.

Background & aims: Patients undergoing major gastrointestinal surgery may be in particular need of nutritional therapy due to potential pre-existing disease-related malnutrition and the impact of surgical procedures. Peripheral parenteral nutrition (PPN), delivered via a peripheral catheter, is aligned with the Enhanced Recovery After Surgery (ERAS) concept of minimally invasive interventions where possible. However, uncertainties regarding perioperative PPN for patients undergoing major gastrointestinal surgery arise, in part, due to lack of clinical guidelines. This paper aims to provide practical guidance on perioperative PPN, within the framework of ERAS. Methods: A panel of surgeons and nurses convened to identify knowledge gaps and share their best practice experience regarding PPN provision for patients undergoing major gastrointestinal surgery. Clinical needs were identified and addressed based on the panel's experience and a narrative review. Results: Key topics addressed include how PPN can support ERAS nutritional recommendations, identifying gastrointestinal surgery patient subgroups who are likely to benefit from PPN, perioperative timepoints when PPN may be required, and optimizing the delivery of PPN. An algorithm to support the identification and management of patients' perioperative nutritional needs was developed. Conclusions: This paper aims to assist healthcare providers by addressing best practice questions related to the use of PPN during the critical perioperative period within the ERAS concept. This may facilitate timely nutritional intervention to help improve postoperative clinical outcomes and quality of life for patients undergoing major gastrointestinal surgery.

The purpose of the present study was to evaluate zuclopenthixol acetate in Viscoleo, a new preparation to be administered once every 3 days, in the early treatment of acute psychotic episodes and acute deterioration of chronic psychosis. 21 cases were included in the study: patients received 1 to 3 injections. Clinical evaluation was made at 24, 48 and 72 hours after each injection, using the Clinical Global Impressions (CGI) and the Brief Psychiatric Rating Scale (BPRS). Results at end-point indicated a marked or moderate therapeutic effect in the 11 cases of acute psychosis. A statistically significant decrease was observed for the total BPRS score as well as for its subscales. Among 8 cases of exacerbation of chronic psychosis, 4 patients showed a moderate therapeutic effect, and minimal or no effect was found in the other 4 subjects. The total BPRS decreased significantly, but to a lesser extent than for acute psychosis. Two patients suffering from mania showed a moderate therapeutic effect according to CGI. 8 cases of acute psychosis and 5 cases of chronic psychosis did not suffer from any neurological side-effects. Plasma concentration measurements suggest that a dose of 50 mg per 3 days may be sufficient for early treatment of most acutely ill psychotic patients.

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