Perioperative Ernährung – Metabolische Konditionierung

Abstract

Surgery elicits a series of metabolic stress reactions. Stress hormones and inflammatory mediators (i. e. cytokines) cause catabolism of glycogen, lipids and proteins. Glucose, free fatty acids, and amino acids are released for the tasks of healing and immune response. Thus, substrates are diverted from normal purposes such as physical activity. However, the patient requires anabolic metabolism to reach optimal recovery. Many stress-reducing measures have proven to minimize catabolism and support anabolism, and have led to faster and better rehabilitation, even after major surgical trauma. The so-called „Enhanced Recovery After Surgery” (ERAS) concepts focus on better preoperative preparation, anaesthesia, analgesia, and early mobilisation as well as improved supplies of nutritional substrates. This includes generally reduced preoperative fasting, preoperative carbohydrate loading, no interruption of oral nutritional intake after surgery, if possible, and a perioperative consumption of oral nutritional supplements. Studies have shown that such nutritional practices contribute to perioperative stabilisation of the organism by reducing postoperative insulin resistance, minimising protein catabolism, decreasing oxidative stress, and improving various organ functions. Further consequences are improved perioperative condition, attenuated depletion of muscle mass, reduction of postoperative complications, and reduced intensive care unit and hospital stays.