Chapter 77
- Nutritional Aspects
- John K. Stene
- Thomas C. Vary
Nutrition has an important impact on the quality of human protoplasm
and ultimately on a patient's fitness for surgery. Anesthesiologists need a fundamental
knowledge of nutritional principles to develop a logical approach to nutritional
support for the surgical patient during the perioperative period. Changes in energy
use induced by starvation (fasting), trauma, and critical illness also have implications
for anesthesia care. Amino acid patterns in plasma that vary with dietary changes
and in certain pathologic conditions affect plasma binding of drugs and alter neurotransmitter
precursor availability.[1]
The choice of anesthetic
technique may affect the patient's use of energy substrates and nutritional needs.
[2]
This chapter concentrates on the perioperative nutritional care
of the surgical patient in the intensive care unit and in the operating room. Although
much of the information in this chapter is derived from studies on centrally administered
total parenteral nutrition (TPN), perioperative nutritional support may also be administered
by peripheral veins and is increasingly being administered enterally through the
gut. Physiologic principles for nutritional support are stressed in the chapter.
Such physiologic knowledge can help the anesthesiologist decide who will benefit
from nutritional support, whether to provide parenteral or enteral nutrition, how
to monitor the patient's response to nutritional support, and what prescription to
write for nutritional support.
