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Metabolic basis for the management of patients undergoing major surgery

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Abstract

After reviewing our current knowledge of the metabolic response to major abdominal surgery, we present two new studies in which we have followed the changes in body composition, physiologic function, and psychological function for up to 1 year after major surgery. In the first study, 46 patients had changes in body composition, physiologic function, and psychological function measured perioperatively and again at intervals up to 1 year. There was an average loss of weight of 3000 grams (maximum at 2 weeks), and the tissue composition of this weight loss was composed of 1400 grams fat, 600 grams protein, and 1000 grams water. Normal body composition had returned to normal in most patients by 6 months. In the second study of 84 patients, deficits of skeletal muscle function and fatigue were found to be greatest at postoperative day 7. Most patients were back to preoperative levels of muscle function and fatigue 30 days after surgery, and nearly all had normal values 90 days after surgery. Based on these studies we outline our management program for the metabolic care of patients undergoing major abdominal surgery.

Résumé

Après avoir passé en revue les connaissances actuelles de la réponse métabolique à la chirurgie abdominale, nous présentons deux nouvelles études dan lesquelles les changements dans la composition corporelle, les fonctions physiologique et psychologique ont été suivies pendant un an après une chirurgie abdominale majeure. Dans la première, comportant 46 patients, la perte de poids corporel moyenne a été de 3000 g (valeur maximale à deux semaines), composé de 1400 g de lipides, 600 g de protéines, et de 1000 g d'eau. La composition corporelle est revenue à la normale six mois plus tard chez la plupart des patients. La deuxième étude a intéressé 74 patients, où le déficit de la fonction musculaire squelletique et la fatigue ont été retrouvés au maximum au 7è jour postopératoire. Le retour aux taux préopératoires a été observé pour la plupart des patients 30 jours après et pour pratiquement tous les opérés, 90 jours après. Nous basant sur les résultats de cette étude, nous avons établi une politique de soutien métabolique pour tout patient ayant une intervention de chirurgie abdominale majeure.

Resumen

Después de revisar el conocimiento actual sobre la respuesta metabólica a la cirugía abdominal, presentamos dos nuevos estudios en los cuales se determinaron los cambios en composición corporal, función fisiológica y estado psicológico por un periodo de hasta un año luego de cirugía mayor. En el primer estudio se midieron tales cambios en 46 pacientes en la fase perioperatorio y a diferentes intervalos hasta un año después de la operación. Se encontró una pérdida promedio de peso corporal de 3000 g (máxima a las dos semanas) y la composición tisular de tal pérdida representada por 1400 g de grasa, 600 g de proteína y 100 g de agua. La composición corporal retornó a su estado normal en el curso de seis meses en la mayoría de los pacientes.

En el segundo estudio, sobre 84 pacientes, se encontraron máximos déficits de la función muscular esquelética y fatiga en el 7° día postoperatorío. La mayoría de los pacientes retornaron a sus niveles preoperatorios de función muscular y de fatiga a los 30 días después de la cirugía y casi todos presentaban valores normales a los 90 días.

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References

  1. Cuthbertson, D.P.: Observations on the disturbance of metabolism produced by injury to the limbs. Q.J. Med.1:237, 1932

    Google Scholar 

  2. Hume, D.M., Egdahl, R.H.: The importance of the brain in the endocrine response to injury. Ann. Surg.150:697, 1959

    Google Scholar 

  3. Clague, M.B., Keir, M.J., Wright, P.D., Johnston, I.D.A.: The effects of nutrition and trauma on whole-body protein metabolism in man. Clin. Sci.65:165, 1983

    Google Scholar 

  4. Cruickshank, A.M., Fraser, W.D., Burns, H.J.G., Van Damme, J., Shenkin, A.: Response of serum interleukin-6 in patients undergoing elective surgery of varying intensity. Clin. Sci.79:161, 1990

    Google Scholar 

  5. Michie, H.R., Spriggs, D.R., Manogue, K.R., Sherman, M.L., Revhaug, A., O'Dwyer, S.T., Arthur, K., Dinarello, C.A., Cerami, A., Wolff, S.M., Kufe, D.W., Wilmore, D.W.: Tumour necrosis factor and endotoxin induce similar metabolic responses in human beings. Surgery104:280, 1988

    Google Scholar 

  6. Flores, E.A., Bistrian, B.R., Pomposelli, J.J., Dinarello, C.A., Blackburn, G.L., Istfan, N.W.: Infusion of tumour necrosis factor/ cachectin promotes muscle catabolism in the rat. J. Clin. Invest.83:1614, 1989

    Google Scholar 

  7. Kinney, J.M., Long, C.L., Gump, F.E., Duke, J.H., Jr.: Tissue composition of weight loss in surgical patients. I. Elective operation. Ann. Surg.168:459, 1968

    Google Scholar 

  8. Hill, G.L.: Body composition research at the University of Auckland: some implications for modern surgical practice. Aust. N.Z. J. Surg.58:13, 1988

    Google Scholar 

  9. Craig, R.P., Tweedle, D., Davidson, H.A., Johnston, I.D.A.: Intravenous glucose, amino acids, and fat in the postoperative period: a controlled evaluation of each substrate. Lancet2:8, 1977

    Google Scholar 

  10. Swaminathan, R., Bradley, J.A., Hill, G.L., Morgan, D.B.: The effect of varying amounts of intravenous glucose on the metabolic changes after surgery. Postgrad. Med. J.55:652, 1980

    Google Scholar 

  11. Schroeder, D.S., Hill, G.L.: Postoperative fatigue: a prospective physiological study of patients undergoing major abdominal surgery. Aust. N.Z. J. Surg.61:774, 1991

    Google Scholar 

  12. Schroeder, D.S., Hill, G.L.: Predicting postoperative fatigue — the importance of preoperative factors. World J. Surg.17:226, 1993

    Google Scholar 

  13. Christensen, T., Kehlet, H.: Postoperative fatigue and changes in nutritional status. Br. J. Surg.71:473, 1984

    Google Scholar 

  14. Schroeder, D., Gillanders, L., Mahr, K., Hill, G.L.: Effects of immediate postoperative enteral nutrition on body composition, muscle function and wound healing. J. Parenter. Enter. Nutr.15:376, 1991

    Google Scholar 

  15. Moore, F.D.: Metabolic Care of the Surgical Patient. Philadelphia, Saunders, 1959

    Google Scholar 

  16. Egbert, L.D., Battit, G.E., Welch, C.E., Bartlett, M.K.: Reduction of postoperative pain by encouragement and instruction of patients-a study of doctor — patient rapport. N. Engl. J. Med.270:825, 1964

    Google Scholar 

  17. Windsor, J.A., Knight, G.S., Hill, G.L.: Wound healing response in surgical patients: recent food intake is more important than nutritional status. Br. J. Surg.75:135, 1988

    Google Scholar 

  18. Morris, W.T.: Prophylaxis against sepsis in patients undergoing major surgery. World J. Surg.17:178, 1993

    Google Scholar 

  19. Kehlet, H.: Modification of responses to surgery and anaesthesia by neural blockade. In Neural Blockade in Clinical Anaesthesia and Management of Pain, M.J. Cousins, P.O. Bridenhagh, editors. Philadelphia, Lippincott, 1987

    Google Scholar 

  20. Roberts, J.P., Roberts, J.D., Skinner, C., Shires, G.T., III, Illner, H., Canizaro, P.C., Shires, G.T.: Extracellular fluid deficit following operation and its correction with Ringer's lactate. Ann. Surg.202:1, 1985

    Google Scholar 

  21. NIH: National Institute of Health Consensus Development Statement on Perioperative Red Cell Transfusion, Vol. 7. US Department of Health and Human Sciences, Bethesda, 1988

    Google Scholar 

  22. Yeung, C.K., Young, G.A., Hackett, A.F., Hill, G.L.: Fine needle catheter jejunostomy: an assessment of a new method of nutritional support after major gastrointestinal surgery. Br. J. Surg.66:727, 1979

    Google Scholar 

  23. Bower, R.H.: A unique enteral formula as adjunctive therapy for septic and critically ill patients: multicentered study design and rationale. Nutrition16:92, 1990

    Google Scholar 

  24. Collins, J.P., Oxby, C.B., and Hill, G.L.: Intravenous amino acids and intravenous hyperalimentation as protein-sparing therapy after major surgery: a controlled clinical trial. Lancet1:788, 1978

    Google Scholar 

  25. Jiang, Z.-M., He, G.-Z., Zhang, S.-Y., Wang, X., Yang, N., Zhu, Y., Wilmore, D.W.: Low dose growth hormone and hypocaloric nutrition alternate the protein catabolic response after major operation. Ann. Surg.210:513, 1989

    Google Scholar 

  26. Inculet, R.I., Finlay, R.J., Duff, J.H., Pace, R., Rose, C., Groves, A.C., Woolf, L.I.: Insulin decreases muscle protein loss after operative trauma in man. Surgery99:752, 1986

    Google Scholar 

  27. Ziegler, T.R., Young, L.S., Ferrari-Baliviera, E., Demling, R.H., Wilmore, D.W.: Use of growth hormone combined with nutritional support in a critical care unit. J. Parenter. Enter. Nutr.14:574, 1990

    Google Scholar 

  28. Isaksson, B., Edlund, Y., Gelin, L.E., Sölvell, L.: The value of protein enriched diet in patients with peptic ulcer. Acta Chir. Scand.118:418, 1959

    Google Scholar 

  29. Neugebauer, E., Troidl, H., Spangenberger, W., Dietrich, A., Lefering, R.: Conventional versus laparoscopic cholecystectomy and the randomised controlled trial. Br. J. Surg.78:150, 1991

    Google Scholar 

  30. Cuschieri, A.: Personal communication, 1991

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Authors and Affiliations

  1. University Department of Surgery, Auckland Hospital, Park Road, Auckland, New Zealand

    Graham L. Hill M.D., F.R.A.C.S., Richard G. Douglas M.B., Ch.B. & David Schroeder M.B. Ch.B., F.R.A.C.S.

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  1. Graham L. Hill M.D., F.R.A.C.S.
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  2. Richard G. Douglas M.B., Ch.B.
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  3. David Schroeder M.B. Ch.B., F.R.A.C.S.
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Hill, G.L., Douglas, R.G. & Schroeder, D. Metabolic basis for the management of patients undergoing major surgery. World J. Surg. 17, 146–153 (1993). https://doi.org/10.1007/BF01658920

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