Nutrición perioperatoria en protocolos quirúrgicos para una mejor recuperación postoperatoria (Protocolo ERAS)

Abstract

The trauma involved in any surgical procedure, even if elective, causes a metabolic stress response characterized by postoperative insulin resistance (PIR). PIR is considered a surgical stress marker and is associated with increased morbidity and postoperative length of stay. PIR worsens when the patient is operated in a state of prolonged preoperative fasting or when postoperative feeding is delayed. The ERAS Protocols (Enhanced Recovery After Surgery) includes anesthetic, surgical, kinesiology, nutritional and nursing interventions aimed to modulate PIR. The nutritional perioperative interventions in the ERAS protocols, focus on avoiding prolonged preoperative fasting by oral carbohydrate loading up to two hours before surgery, accompanied by early postoperative feeding through the digestive tube. These nutritional perioperative interventions are safe and effective to reduce complications and postoperative stay, even in patients with well controlled type 2 diabetes. Nevertheless, their implementation and compliance are rather low, therefore, we must continue to make efforts in order to change perioperative nutritional management of our patients to achieve the best possible postoperative recovery.

Nursing diagnoses in adults and elderlies in the preoperative period: a comparative study

“…The Ministry of Health's investment increased from R $ 1.04 billion to R $ 1.33 billion, corresponding to a growth of 27.2% in order to seek measures to prevent and control risks (3) . In addition, the number of general and proctologic surgeries increased to 51 and 186 quarterly surgeries, respectively (4) .…”

“…The preoperative phase in this context is understood from the moment the patient makes the decision on the surgical intervention until the transfer to the operating room table (4) . Thus, it is the responsibility of the nurse to plan the patient's care in the preoperative period, including attending to their biopsychospiritual needs, as well as providing guidance on the surgical procedure, physical preparation and risk prevention.…”

Acerto Project: Impact on Assistance of a Public Emergency Hospital

“…In this study, a decrease was observed both in the time of reintroduction of the diet and in the day of the adequate nutritional supply. This factor contributes to the patient’s lower catabolism and, also, to the possibility of earlier discharge as stated in the ACERTO 6 nutritional intervention guidelines and in the international literature as an ideal form of care 22 . These data corroborate with the recent literature in which patients with earlier return to their usual diet are discharged earlier 13 , 15 .…”

Accelerated recovery after surgical treatment in patients with cáncer of the colon

“…Según Sánchez Cala et al (13) el 97% de los enfermos que se operaron con el protocolo ERAS presentaron un 87% de defecación entre el 2 o y 3 er día, mientras que, con cuidados tradicionales, el 73% de los enfermos presentaban defecación entre el 6 o y 7 o día postoperatorio, mostrando resultados similares a los obtenidos en esta muestra.…”