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Preoperative Metabolic Conditioning
1. Preoperative metabolic conditioning J.-Philipp Breuer Departments of Anaesthesiology and Intensive Care Medicine Campus Charité Mitte und Campus Virchow-Klinikum CHARITÉ – Universitätsmedizin Berlin
3. ± 49 min ± 30 min 5 h 8 min 3 h 8 min 4 h 30 min 4 h 30 min to 20 h 15 h 12 h 30 min 14 h 20 min 12 h 28 min Solids Fluids 95 % CI SD Range Median Mean 2 Number of cases 6 4 2 0 8 10 12 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Fasting (h) Preoperative Fasting (n = 153) Pearse et al Eur J Anesthesiol 1999 Preoperative metabolic conditioning
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5. Perioperative Nutrition Metabolic impact Hyperglycemia Morbidity, Mortality Protein breakdown Depletion Rehabilitation – Length of stay Insulin resistance Intracellular energy sources Oxidative stress Organ function Intestinal barriers Bacterial translocation Insufficient nutritional status + Surgical trauma Breuer et al Akt Ernaehr Med 2006 Preoperative metabolic conditioning
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11. Postoperative Insulin Resistance Thorell et al. Curr Opin Clin Nutr Metab Care 1999 p < 0.001, ANOVA n = 6-13 Insulin sensitiviy (%) Lapar. Cholecyst- ectomy Hernio- tomy Chole- cyst- ectomy Colo- rectal- surgery Preoperative metabolic conditioning 0 20 40 60 80 100
12. Change in insulin sensitivity (%) 0 -10 -20 -30 -40 -50 -60 Glc i.v. Control p < 0.01 0 -10 -20 -30 -40 -50 -60 Placebo p < 0.05 Verum Ljungqvist et al J Am Coll Surg 1994 Soop et al Am J Physiol Endokrinol Metab 2001 Glucose i.v. before cholecystectomy Glucose oral before hip replacement n = 15 n = 12 Preoperative metabolic conditioning
13. Preoperative carbohydrates & Skeletal muscle mass Double blind, randomised, placebo-controlled Yuill et al Clin Nutr 2005 TSF = triceps skinfold thickness, AMC = mid-arm muscle circumference (CHOD = 12.6g CHOD/100mL) Evening before surgery: 800mL (Placebo/CHOD) Morning 2 hours before surgery: 400mL (Placebo/CHOD) N = 65 Preoperative metabolic conditioning p=0.05
14. Preoperative Carbohydrates & Skeletal muscle mass randomised, controlled Noblet et al Colorec Dis 2006 n = 12, CHOD (100g/800mL evening + 50g/400mL 3h preop) n = 11, Water (800mL evening+ 400mL 3h preop) n = 12, Fasting (NPO after midnight) Preoperative metabolic conditioning 10 5.7 13 p=0.01 p=0.06 -11% p=0.05 -8% p=0.7 -5% p=0.6
15. Carbohydrates before cardiac surgery Double blind, randomised, placebo-controlled Breuer et al Anesth Analg 2006 Preoperative metabolic conditioning
16. van Hoorn et al Nutrition 2005 Preoperative metabolic conditioning
17. Cardiac function van Hoorn et al Nutrition 2005 Preoperative metabolic conditioning
18. Energy status lung van Hoorn et al Nutrition 2005 liver intestine Preoperative metabolic conditioning Oxidative stress
