Nutritional management during perioperative period: Focusing on glucose metabolism and insulin sensitivity

Surgery is invasive, and injures the patient's physiology. Insulin resistance after surgery increases as the surgical procedure become extensive. Noxious stimuli activate sympathetic nerve system, causing inflammation. It also decreases the insulin sensitivity. Furthermore, hemodynamic changes caused by anesthesia, by bleeding from surgical procedure, and/or by hypothermia result in a stress. After surgery, wound repair is required and the increase in catabolism must be kept minimal. In this view of point, appropriate nutritional management during perioperative period helps prevent catabolism. Blood glucose concentration was recognized recently as an important factor influencing to the outcome. Intensive insulin therapy, however, is not agreed is not upon universally. Shortage of glucose induces glyconeogenesis from amino acids and /or lipids, further causing extensive catabolism. For reducing this, glucose administration is important as well as a good static blood glucose level. Protocols like ERAS (Enhanced Recovery After Surgery) were being proposed for quick recovery after surgery. This recommends drinking 400 mL of clear water containing carbohydrate 2 hours before anesthesia, but it does not include glucose administration during surgery. For prolonged surgery, patients obviously need good nutritional support. A small dose of glucose during surgery effectively suppresses ketogenesis, and attenuates postoperative insulin resistance. In this chapter, we intend to describe the amount of carbohydrate required for the day of surgery, and the way to give carbohydrate. We propose a method of evaluating insulin sensitivity after surgery.