[MEDtalk] Artificial Nutritional Support in Surgery: From Past to Present
Daniel Cardona Pera
Clinical Pharmacist, Consultant
Hospital de la Santa Creu i Sant Pau, Spain
Parenteral nutrition (PN) and enteral nutrition (EN) indications in surgery have changed in the last 40 years, especially in the context of less aggressiveness procedures (fast track, laparoscopy). Indeed, we still consider the immediate postoperative period of major surgery as an indication for PN: gastrectomy (gastric cancer); esophagectomy (esophageal cancer); duodenopancretectomy (pancreatic cancer); excision of intestinal areas and other organs due to sarcoma or short bowel syndrome. According to a review of the indications with more than 40 years in our hospitals, these prescriptions were due to malnutrition prior to surgery. Currently, most hospitals control the nutritional status in the preoperative period and begin oral intake 48 h after surgery.
Since this new type of surgery is used, especially colorectal surgery, the indications of PN or EN have increased in postoperative complications such as suture failures, which can involve a second surgery for the confection of intestinal ostomies. As a consequence, liquid control and nutritional problems are frequent in these patients. Besides, a new group has been included in the postsurgery PN indications that elderly patients with subocclusion or incarcerated hernias as surgery complications, with a high incidence of severe malnutrition such as sarcopenia with significant loss of muscle mass due to age. The fluidotherapy and their calories requirements will be different.
Daniel Cardona Pera is a recently retired Clinical Pharmacist at Hospital de la Santa Creu i Sant Pau, Barcelona. His field of expertise is Clinical Nutrition, being responsible of the Artificial Nutrition Section along almost 40 years. He has also been Associate Professor at the Department of Nutrition and Bromatology of the School of Pharmacy, University of Barcelona.
He has authored more than 100 publications, most of them on clinical nutrition. He is a member of the Reial Acadèmia de Farmàcia de Catalunya with the subject “Clinical Pharmacist in parenteral nutrition: from preparation to clinical monitoring”.
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