Anticatabolic effects of avoiding preoperative fasting by intravenous hypocaloric nutrition: a randomized clinical trial.

Objective: We tested the hypothesis that the avoidance of preoperative fasting by hypocaloric nutrition attenuates protein catabolism after surgery.

Summary Background Data: Prolonged fasting before major abdominal procedures has been demonstrated to accentuate the catabolic response to surgery.

Methods: Twenty-two patients undergoing colorectal cancer surgery were randomly assigned to receive glucose and amino acids intravenously starting either 20 hours before the operation or with surgical skin incision.

Perioperative amino acid supplementation of hypocaloric glucose does not impair glucose metabolism after surgery.

We tested the hypothesis that perioperative amino acid supplementation of hypocaloric dextrose would attenuate the inhibitory effect of glucose on endogenous glucose production after surgery. Sixteen patients undergoing colorectal cancer surgery were randomly assigned to receive intravenous glucose either with or without amino acids. Nutrition was administered over 48 hours from surgical skin incision until the second postoperative day.

Parenteral nutrition and protein sparing after surgery: do we need glucose?

Although capable of inducing an anabolic state after surgery, parenteral nutrition, including glucose, leads to hyperglycemia. Even moderate increases in blood glucose are associated with poor surgical outcome. We examined the hypothesis that amino acids, in the absence of glucose supply, spare protein while preventing hyperglycemia.

Type 2 diabetes mellitus and the catabolic response to surgery.

Background: The authors tested the hypothesis that the catabolic responses to colorectal surgery are amplified in the presence of type 2 diabetes mellitus.

Methods: Seven nondiabetic and seven diabetic patients underwent a 6-h stable isotope infusion study (3 h fasted, 3-h glucose infusion at 4 mg . kg .

The anabolic effect of epidural blockade requires energy and substrate supply.

Background: The authors examined the hypothesis that continuous thoracic epidural blockade with local anesthetic and opioid, in contrast to patient-controlled intravenous analgesia with morphine, stimulates postoperative whole body protein synthesis during combined provision of energy (4 mg x kg(-1) x min(-1) glucose) and amino acids (0.02 ml x kg(-1) x min(-1) Travasol 10%, equivalent to approximately 2.9 g x kg(-1) x day(-1)).