ABREVIAÇÃO DE JEJUM NO PRÉ-OPERATÓRIO DE CIRURGIAS ELETIVAS: UMA REVISÃO INTEGRATIVA
Abreviação de jejum no pré-operatório de cirurgias eletivas
Palavras-chave:
abreviação de jejum, carboidratos, jejum pré-operatório, proteínasResumo
Fundamentos: A resposta metabólica associada ao trauma cirúrgico pode ser mais agressiva decorrente de jejum prolongado, contribuindo para o aumento da resistência à insulina e consequentemente exacerbação do catabolismo pós-operatório com aumento da perda de gordura corporal e reservas de proteína. Diretrizes publicadas nos últimos anos por países como Estados Unidos, Canadá e da Europa recomendam diminuição do tempo de jejum pré-operatório para 6-8 horas para alimentos sólidos e 2 horas para líquidos claros. Objetivo: revisar os efeitos da abreviação de jejum em pacientes submetidos a cirurgias eletivas. Métodos: revisão da literatura, nos meses de agosto a outubro de 2023 através de seleção dos estudos nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde; National Center for Biotechnology Information; Scientific Eletronic Library Online. Resultados: Foram analisados cinco artigos que atenderam aos critérios de inclusão, sendo estudos randomizados realizados no Brasil. Conclusão: a abreviação do jejum pode melhorar a clínica dos pacientes contribuindo para a aceleração da recuperação, além de reduzir tempo e custos de internamento, sendo prática segura e recomendada por diretrizes nacionais e internacionais.
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Referências
Aguilar-Nascimento JE de, Dock-Nascimento DB, Faria MSM, Maria EV, Yonamine F, Silva MR, et al. Preoperative ingestion of carbohydrates diminishes the occurence of postoperative gastrointestinal symptoms in patients submitted to cholecystectomy. ABCD, arq bras cir dig. 2007 Jun;20:77–80.
Bilku D, Dennison A, Hall T, Metcalfe M, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014 Jan;96(1):15–22.
Código de Ética Médica: Resolução CFM no 2.217, de 27 de setembro de 2018 , modificada pelas Resoluções CFM no 2.222/2018 e 2.226/2019 / Conselho Federal de Medicina – Brasília: Conselho Federal de Medicina, 2019.
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition. 2021 Jul;40(7):4745–61.
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. Revista do Colégio Brasileiro de Cirurgiões. 2017 Dec;44(6):633–48.
Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, Kuo CI, Soriano SG, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration—A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting*. Anesthesiology. 2023 Feb 1;138(2):132–51.
de Aguilar-Nascimento JE, de Almeida Dias AL, Dock-Nascimento DB, Correia MIT, Campos AC, Portari-Filho PE, et al. Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study. Ther Clin Risk Manag. 2014 Feb 14;10:107–12.
Lobo DN, Hendry PO, Rodrigues G, Marciani L, Totman JJ, Wright JW, et al. Gastric emptying of three liquid oral preoperative metabolic preconditioning regimens measured by magnetic resonance imaging in healthy adult volunteers: A randomised double-blind, crossover study. Clinical Nutrition. 2009 Dec;28(6):636–41.
Reis PGDA, 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):e20192175.
Aguilar-Nascimento JE de, Bicudo-Salomão A, Caporossi C, Silva R de M, Cardoso EA, Santos TP. Acerto Project: Outcome Evaluation After The Implementation Of A Multidisciplinary Protocol Of Peri-Operative Care In General Surgery. Rev Col Bras Cir. 2006 Jun;33(3):181–8.
De Carvalho CS, Silva TH, André JCS, De Barros LAS, Ferreira AA, Murad LB, et al. Preoperative Fasting Abbreviation With Whey Protein Reduces the Occurrence of Postoperative Complications in Patients With Head and Neck Cancer: A Randomized Clinical Trial. Nut in Clin Prac. 2021 Jun;36(3):665–72.
Oliveira KGB de, Balsan M, Oliveira S de S, Aguilar-Nascimento JE. Does Abbreviation of Preoperative Fasting to Two Hours with Carbohydrates Increase the Anesthetic Risk? 2009 [cited 2023 Dec 15]; Available from: https://www.scielo.br/j/rba/a/V9JKTb7L7LdNrF9hvHNDXJr/?format=pdf&lang=pt
Apfelbaum et al. 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. Anesthesiology. 2011;114(3):495–511.
Abola RE, Gan TJ. Preoperative Fasting Guidelines: Why Are We Not Following Them?: The Time to Act Is NOW. Anesthesia & Analgesia. 2017 Apr;124(4):1041–3.
Wendler E, Nassif PAN, Malafaia O, Brites Neto JL, Ribeiro JGA, Proença LBD, et al. Shorten preoperative fasting and introducing early eating assistance in recovery after gastrojejunal bypass? ABCD, arq bras cir dig. 2021;34(3):e1606.
de Andrade GRG. Organic inflammatory response to reduced preoperative fasting time, with a carbohydrate and protein enriched solution; a randomized trial. NUTRICION HOSPITALARIA. 2015 Aug 1;(2):953–7.
Feguri GR, Lima PRL, Lopes AM, Roledo A, Marchese M, Trevisan M, et al. Clinical and metabolic results of fasting abbreviation with carbohydrates in coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc. 2012;27(1):7–17.
Zani FVB, Aguilar-Nascimento JE, Nascimento DBD, Silva AMCD, Caporossi FS, Caporossi C. Benefits of maltodextrin intake 2 hours before cholecystectomy by laparotomy in respiratory function and functional capacity: a prospective randomized clinical trial. Einstein (São Paulo). 2015 Jun;13(2):249–54.
Carvalho CALDB, Carvalho AAD, Preza ADG, Nogueira PLB, Mendes KBV, Dock-Nascimento DB, et al. Metabolic and Inflammatory Benefits of Reducing Preoperative Fasting Time in Pediatric Surgery. Rev Col Bras Cir. 2020;47:e20202353.
Carvalho CALDB, Carvalho AAD, Nogueira PLB, Aguilar-Nascimento JED. Changing paradigms in preoperative fasting: results of a joint effort in Pediatric Surgery. ABCD, arq bras cir dig. 2017 Mar;30(1):7–10.
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. Anesthesia & Analgesia. 2018 Jun;126(6):1883–95.
