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Preoperative vs Intraoperative Initiation of Parenteral Nutrition is Associated with Increased Postoperative Synthesis of Albumin but not Fibrinogen in Patients Undergoing Colorectal Surgery and Receiving Epidural Analgesia
Author(s) -
Wykes Linda J.,
Nitschmann Evan P.,
Mazza Louise,
Meterissian Sarkis,
Schricker Thomas
Publication year - 2007
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.21.5.a162-b
Subject(s) - medicine , anabolism , albumin , parenteral nutrition , anesthesia , colorectal surgery , surgery , abdominal surgery
Hypocaloric parenteral nutrition (PN) promotes an anabolic response at the whole body level after major abdominal surgery if effective pain relief is provided by epidural analgesia. Hypothesis. Avoiding preoperative fasting by initiating PN before surgery promotes whole body anabolism and synthesis of plasma proteins in patients receiving epidural analgesia. Methods. Twelve metabolically healthy patients (ASA class I and II) undergoing resection for colorectal carcinoma were randomized to receive PN (glucose 2.5 g/kg.d, amino acids 1.0 g/kg.d) starting 24h before surgery (PreOp) or at skin incision (IntraOp). Whole body leucine balance was determined by [1‐ 13 C]leucine infusions 24h before and 48h after surgery. Fractional (FSR %/d) and absolute (ASR umol/kg.d) synthesis of albumin, fibrinogen, and the total plasma protein pool (TPP) were determined 48h post surgery by [ring‐ 2 H 5 ]phenylalanine tracer. Results. The postoperative increase in leucine balance was greater with PreOp than Intra‐Op PN initiation (17.4 ±2 vs. 4.1±2 umol/kg.h, p<0.001). Conclusion . Avoiding preoperative fasting, by initiating hypocaloric PN before surgery in the presence of optimal postoperative pain relief by epidural analgesia improves whole body protein balance and albumin synthesis after colorectal surgery. (Supported by CIHR)