NUTRITION IN SURGICAL CONDITIONS: POSTOPERATIVE DIET, PARENTERAL NUTRITION
Postoperative diet
The dietary progression depends upon the nature of the surgery. Food and fluids cannot be given orally until peristalsis has returned. Parenteral fluids maintain fluid and electrolyte balances.
When gastric secretions have begun and peristalsis resumes, clear fluids are given with the initial amounts being 30 to 60 ml. Warm fluids such as tea and broth are better than cold fluids. Patients respond better to solid foods than to liquid foods, and a very low-residue diet given in small amounts is usually the first order. Foods that are high in protein and fat are less distending than those high in carbohydrate. The patient should eat slowly and in small amounts to reduce the amount of air that is swallowed. The diet progresses to a soft fiber-restricted diet and then a regular diet, usually within a few days of surgery.
Parenteral nutrition
Parenteral fluids may consist of physiologic saline or with additions of 5 per cent glucose, amino acids, electrolytes, vitamins, and medications. They are not nutritionally adequate, but they maintain fluid and electrolyte balance during the immediate postoperative period. One liter of 5 per cent glucose contains 50 gm glucose or 200 kcal. Even 400 kcal in a day can be beneficial in reducing tissue breakdown.
Total parenteral nutrition (hyper-alimentation). A number of situations arise in which oral or tube feedings cannot be used for several weeks; for example, prolonged coma, severe uncontrolled malabsorption, extensive burns, and gastrointestinal fistulas. By techniques developed within the last decade a nutritionally adequate hypertonic solution consisting of glucose, protein hydrolysates, minerals, and vitamins can be given by means of an indwelling catheter into the superior vena cava. The high rate of blood flow brings about rapid dilution of the solution, and full nutritional requirements can be met indefinitely.
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GENERAL HEALTH
