TY - CHAP M1 - Book, Section TI - Nutrition in Perioperative & Critical Care A1 - Butterworth IV, John F. A1 - Mackey, David C. A1 - Wasnick, John D. Y1 - 2022 N1 - T2 - Morgan & Mikhail’s Clinical Anesthesiology, 7e AB - KEY CONCEPTS The fit, previously well-nourished patient undergoing elective surgery could be fasted for up to a week postoperatively without apparent adverse effect on outcomes, provided that fluid and electrolyte needs are met. On the other hand, it is well established in multiple studies that malnourished patients benefit from nutritional repletion via either enteral or parenteral routes prior to surgery. The indications for total parenteral nutrition (TPN) are narrow, including those patients who cannot absorb enteral solutions (eg, small bowel obstruction, short gut syndrome); partial parenteral nutrition may be indicated to supplement enteral nutrition (EN) when EN cannot fully provide for nutritional needs. TPN will generally require a venous access line with its catheter tip in the superior vena cava. The line or port through which the TPN solution will be infused should be dedicated to this purpose, if at all possible, and strict aseptic techniques should be employed for insertion and care of the catheter. In a patient with critical illness, discontinuing an EN infusion may require multiple potentially dangerous adjustments in insulin infusions and maintenance of intravenous fluid rates. Meanwhile, the evidence is sparse that EN infusions delivered through an appropriately sited gastrointestinal feeding tube increase the risk of aspiration pneumonitis. Regardless of whether the TPN infusion is continued, reduced, replaced with 10% dextrose, or stopped, blood glucose monitoring will be needed during all but short, minor surgical procedures. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1190611294 ER -