Abreviação do jejum pré-operatório em pacientes submetidos a cirurgia oncológica em um hospital universitário / Abbreviation of preoperative fasting in patients undergoing oncological surgery in a university hospital
DOI:
https://doi.org/10.34119/bjhrv4n5-390Keywords:
Jejum pré-operatório, Abreviação de jejum, Maltodextrina, Cirurgia oncológica.Abstract
O trabalho avaliou o efeito da abreviação do jejum pré-operatório sobre a taxa de intercorrências, complicações pós-operatórias e tempo de internação hospitalar em pacientes submetidos a cirurgia oncológica em um hospital universitário. Tratou-se de estudo de intervenção com temporalidade mista, controlado, com pacientes adultos e idosos, candidatos a cirurgia eletiva por câncer. O grupo jejum tradicional (controle) foi submetido a jejum após a ceia. O grupo jejum abreviado (intervenção) recebeu 200mL de solução de carboidrato (maltodextrina) a 12,5%, às 6 horas da manhã no dia da cirurgia. Os demais cuidados perioperatórios foram semelhantes nos dois grupos. O tempo de jejum, a ocorrência de complicações perioperatórias, náuseas e vômitos e o tempo para retorno da função intestinal após a cirurgia foram monitorados. Dosagens de glicemia, PC-r e proteínas totais e frações, o tempo de internação, o número de óbitos e reinternações foram registradas. A maioria dos pacientes incluídos foram submetidos a cirurgia por câncer de trato gastrointestinal baixo. Como resultados, foi observado que a intervenção reduziu o tempo de jejum pré-operatório de 12 para 3 horas (p=0,0001). Nenhuma complicação intraoperatória foi relacionada à intervenção. A taxa de náuseas (p=0,6749), vômitos (p= 0,3512) e o tempo para primeira evacuação (p=0,1240) não foi alterado. A ocorrência de infecção hospitalar e de ferida operatória, sepse, deiscência de anastomoses e fístulas foi semelhante entre os grupos (todos com p>0,05). O grupo prospectivo apresentou no pós-operatório maior concentração de PC-r (21,64 x 11,18 mg/dL, p= 0,0206), de albumina plasmática (3,53 x 2,41 g/dL, p= 0,0230) e menor glicemia (81 x 116 mg/dL, p= 0,0322). O tempo de internação (p= 0,7860), a taxa de óbitos (p=1,0000) e readmissões (p= 1,0000) não foi alterada. A intervenção reduziu o tempo de jejum pré-operatório a um nível aceitável, de forma segura. A carga de carboidrato oferecida pode ter contribuído para o controle da glicemia no pós-operatório.
References
Abela G. The potential benefits and harms of early feeding post-surgery: a literature review. Int Wound J. 2017;14(5):870–3.
Aguiar FJB, Ferreira-Júnior M, Sales MM, Cruz-Neto LM, Fonseca LAM, Sumita NM, et al. Proteína C reativa: Aplicações clínicas e propostas para utilização racional. Rev Assoc Med Bras. 2013;59(1):85–92.
Aguilar-Nascimento JE. ACERTO: Acelerando a Recuperação Total Pós-operatória. 3ª ed. Rio de Janeiro: Rubio; 2016. 367 p.
Ali R, Baracos VE, Sawyer MB, Bianchi L, Roberts S, Assenat E, et al. Lean body mass as an independent determinant of dose-limiting toxicity and neuropathy in patients with colon cancer treated with FOLFOX regimens. Cancer Med. 2016;5(4):607–16.
American Society of Anesthesiologists (ASA). Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: An up dated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126(3):376-393.
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48.
Barbosa LRLS, Lacerda-Filho A, Barbosa LCLS. Immediate preoperative nutritional status of patients with colorectal cancer: A warning. Arq Gastroenterol. 2014;51(4):331–6.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
Conselho Federal de Medicina (Brasil). Resolução 2.174, de 14 de dezembro de 2017. Dispõe sobre a prática do ato anestésico e revoga a Resolução CFM nº 1.802/2006. Diário Oficial da União 27 fev 2018; Seção 1.
Burden ST, Hill J, Shaffer JL, Todd C. Nutritional status of preoperative colorectal cancer patients. J Hum Nutr Diet. 2010;23(4):402–7.
Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced recovery after surgery (ERAS®) society recommendations. Clin Nutr. 2013;32(6):879–87.
Citak E, Tulek Z, Uzel O. Nutritional status in patients with head and neck cancer undergoing radiotherapy: a longitudinal study. Support Care Cancer. 2019;27(1):239–47.
Correia MITD, Da Silva RG. The impact of early nutrition on metabolic response and postoperative ileus. Curr Opin Clin Nutr Metab Care. 2004;7(5):577–83.
Costa MD de S, Vieira de Melo CYS, Amorim ACR de, Cipriano Torres D de O, dos Santos ACO. Association between nutritional status, inflammatory condition, and prognostic indexes with postoperative complications and clinical outcome of patients with gastrointestinal neoplasia. Nutr Cancer. 2016;68(7):1108–14.
Dag A, Colak T, Turkmenoglu O, Gundogdu R, Aydin S. A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery. Clinics. 2011;66(12):2001–5.
De Aguilar-Nascimento JE, Dock-Nascimento DB. Reducing preoperative fasting time: A trend based on evidence. World J Gastrointest Surg. 2010;2(3):57.
De Aguilar-Nascimento JE, Salomão AB, Waitzberg DL, Dock-Nascimento DB, Correa MITD, Campos ACL, et al. ACERTO guidelines of perioperative nutritional interventions in elective general surgery. Rev Col Bras Cir. 2017;44(6):633–48.
De Oliveira KGB, Balsan M, Oliveira SDS, Aguilar-Nascimento JE. A abreviação do jejum pré-operatório para duas horas com carboidratos aumenta o risco anestésico? Rev Bras Anestesiol. 2009;59(5):577–84.
De Pinho NB, Martucci RB, Rodrigues VD, D’Almeida CA, Thuler LCS, Saunders C, et al., Malnutrition associated with nutritional impact symptoms and localization of the disease: Results of a multicentric research on oncological nutrition. Clin Nutr. 2019;38(3): 1274-1279.
Diks J, Van Hoorn DEC, Nijveldt RJ, Boelens PG, Hofman Z, Bouritius H, et al. Preoperative fasting: An outdated concept? J Parenter Enter Nutr. 2005;29(4):298–304.
Faria MSM, De Aguilar-Nascimento JE, Pimenta OS, Alvarenga LC, Dock-Nascimento DB, Slhessarenko N. Preoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-cholecystectomy: A randomized, controlled, clinical trial. World J Surg. 2009;33(6):1158–64.
Fiore Junior F, Bialocerkowski A, Browning L, Faragher IG, Denehy L. Criteria to determine readiness for hospital discharge following colorectal surgery: an international consensus using the delphi technique. Dis Colon Rectum. 2012;55(4):416–23.
Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. New Engl J Med Mech. 1999;340(6):448–54.
Gianotti L, Biffi R, Sandini M, Marrelli D, Vignali A, Caccialanza R, et al. Preoperative Oral Carbohydrate Load Versus Placebo in Major Elective Abdominal Surgery (PROCY). Ann Surg. 2018;267(4):623–30.
Gondim CRN, Japiassú AM, Portari Filho PE, de Almeida GF, Kalichsztein M, Nobre GF. Prevenção e tratamento de náuseas e vômitos no período pós-operatório. Rev Bras Ter Intensiva. 2009;21(1):89–95.
Herbert G, Perry R, Andersen H, Atkinson C, Penfold C, Lewis S, et al. Early Enteral Nutrition Within 24 Hours of Lower Gastrointestinal Surgery Versus Later Commencement for Length of Hospital Stay and Postoperative Complications. Cochrane Database Syst Rev. 2019;(7):1–119.
Hu WH, Cajas-Monson LC, Eisenstein S, Parry L, Cosman B, Ramamoorthy S. Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: An analysis of ACS-NSQIP. Nutr J. 2015;14(1):1–6.
Imbelloni LE, Nasiane Pombo IA, de Morais Filho GB. Reduced fasting time improves comfort and satisfaction of elderly patients undergoing anesthesia for hip fracture. Brazilian J Anesthesiol. English Ed. 2015;65(2):117–23.
Kaska M, Grosmanová T, Havel E, Hyšpler R, Petrová Z, Brtko M, et al. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery-a randomized controlled trial. Wien Klin Wochenschr. 2010;122(1–2):23–30.
King E. Preoperative fasting durations for adult elective surgical patients: Convenient for the professional, but detrimental to the patient? A narrative review. J Perioper Pract. 2019;29(12):393–7.
Kondrup J, Ramussen HH, Hamberg O, Stanga Z, Camilo M, Richardson R, et al. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–36.
Lassen K, Coolsen MME, Slim K, Carli F, De Aguilar-Nascimento JE, Schäfer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012;31(6):817–30.
Lin MW, Chen CI, Cheng TT, Huang CC, Tsai JW, Feng GM, et al. Prolonged preoperative fasting induces postoperative insulin resistance by er-stress mediated glut4 down-regulation in skeletal muscles. Int J Med Sci. 2021;18(5):1189–97.
Lipschitz DA. Screening for nutritional status in the elderly. Primary Care. 1994 Mar;21(1):55-67.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery a review. JAMA Surg. 2017;152(3):292–8.
Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy MK, et al. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg. 2019;43(2):299–330.
Makuuchi R, Sugisawa N, Kaji S, Hikage M, Tokunaga M, Tanizawa Y, et al. Enhanced recovery after surgery for gastric cancer and an assessment of preoperative carbohydrate loading. Eur J Surg Oncol. 2017;43(1):210–7.
Mathur S, Plank LD, McCall JL, Shapkov P, McIlroy K, Gillanders LK, et al. Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg. 2010;97(4):485–94.
McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39(2):210–3.
Melloul E, Hübner M, Scott M, Snowden C, Prentis J, Dejong CHC, et al. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg. 2016;40(10):2425–40.
Miller TE, Shaw AD, Mythen MG, Gan TJ. Evidence-Based Perioperative Medicine comes of age: the Perioperative Quality Initiative (POQI). Perioper Med. 2016;5(1):1–4.
Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery after Surgery (ERAS®) Society recommendations. Br J Surg. 2014;101(10):1209–29.
Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: A randomized controlled trial. Color Dis. 2006;8(7):563–9.
Pacilli M, Willetts IE. Endocrine and metabolic response to surgery and its management. In: Godbole, PP; Koyle, MA; Wilcox DT, editor. Pediatric Urology: Surgical Complications and Management. 2nd ed. John Wiley & Sons, Ltd.; 2015. p. 37–47.
Pexe-Machado PA, de Oliveira BD, Dock-Nascimento DB, De Aguilar-Nascimento JE. Shrinking preoperative fast time with maltodextrin and protein hydrolysate in gastrointestinal resections due to cancer. Nutrition. 2013;29(7–8):1054–9.
Ravanini G de AG, Filho PEP, Luna RA, de Oliveira VA. Organic inflammatory response to reduced preoperative fasting time, with a carbohydrate and protein enriched solution; a randomized trial.. Nutr Hosp. 2015;32(2):952–7.
Reis PG de A, Polakowski C, Lopes M, Bussyguin DS, Ferreira RP, Preti VB, et al. Abbreviated preoperative fasting favours postoperative oral intake at lower hospital admission costs for cancer patients. Rev Col Bras Cir. 2019;46(3):1–9.
Rizvanovic N, Adam VN, Causevic S, Dervisevic S, Delibegovic S. A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery. Int J Colorectal Dis. 2019;34(9):1551–61.
Santos RCC, Brandão GRR, Oliveira JGP. Perfil nutricional de pacientes portadores de neoplasia do trato gastrointestinal (TGI) antes, durante e após tratamento sistêmico. Braz. J. Hea. Rev. 2020;3(4):9185-9204.
?im?ek T, ?im?ek HU, Cantürk NZ. Response to trauma and metabolic changes: Posttraumatic metabolism. Turkish J Surg. 2014;30(3):153–9.
Sociedade Brasileira de Nutrição Parenteral e Enteral (SBNPE). Terapia Nutricional no Perioperatório. Projeto Diretrizes. Associação Médica Brasileira. 2011.
Straatman J, Cuesta MA, Tuynman JB, Veenhof AAFA, Bemelman WA, van der Peet DL. C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial. Surg Endosc. 2018;32(6):2877–85.
Strunin L. How long should patients fast before surgery? Time for new guidelines. Br J Anaesth. 1993;70(1):1–4.
Tokunaga R, Sakamoto Y, Nakagawa S, Miyamoto Y, Yoshida N, Oki E, et al. Prognostic nutritional index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer undergoing primary tumor resection. Dis Colon Rectum. 2015;58(11):1048–57.
Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9(SUPPL. 2).
Wang ZG, Wang Q, Wang WJ, Qin HL. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg. 2010;97(3):317–27.
Warren J, Bhalla V, Cresci G. Postoperative diet advancement: surgical dogma vs evidence-based medicine. Nutr Clin Pract. 2011;26(2):115–25.
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50.
Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, et al. American Society for Enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg. 2018;126(6):1883–95.
World Health Organization (WHO). Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018a. Licence: CC BY-NC-SA 3.0 IGO.
World Health Organization [homepage na internet]. Global Cancer Observatory. Cancer Today 2018b [acesso em abr 2020]. Disponível em: https://gco.iarc.fr/today/home
Xu D, Zhu X, Xu Y, Zhang L. Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis. J Int Med Res. 2017;45 (1):22-37.
Yi HC, Ibrahim Z, Zaid ZA, Azuan Mat Daud Z, Nor NB, Omar J, et al. Impact of enhanced recovery after surgery with preoperative whey protein-infused carbohydrate loading and postoperative early oral feeding among surgical gynecologic cancer patients: An open-labelled randomized controlled trial. Nutrients. 2020;12(1):1–14.
Yilmaz N, Çekmen N, Bilgin F, Erten E, Ozhan MO, Cosar A. Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting. J Res Med Sci. 2013;18:827–32. Disponível em < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897064/>
Zhou G, Zhu F, An Y, Qin L, Lv J, Zhao X, et al. Prolonged preoperative fasting and prognosis in critically ill gastrointestinal surgery patients. Asia Pac J Clin Nutr. 2020;29(1):41–7.
