[ Vol. 1 No. 1 ] (January - April 2000 )
Early Postoperative Enteral Nutritional Support in Adult Patients

Krishnan Sriram
Sri Ramichandra Medical College, Madras, India.

The benefits of enteral nutrition (EN) are well known and include attenuation of the stress response, decreased infections, and better nutritional repletion. The traditional approach after abdominal surgery has been to restrict EN until bowel sounds are heard. This is not necessary; intolerance to feeding is often due diminished gastric emptying only. If gastrointesinal (GI) access can be obtained beyond the stomach, then EN can be initiated immediately after abdominal surgery.

At laparotomy, nasoenteral (NE) tubes are inserted and the tip positioned in the duodenum or jejunum. Three to 4 hours after surgery, the effects of anesthetic agents would have worn off and fluid balance stabilized. EN can now be initiated. Half strength formula (0.5 kcal/cc) of a polymeric or semi-elemental preparation is infused at a rate of 30 cc/hr (for the average 60 kg adult). The rate is rapidly advanced every 4 hrs to reach the target requirement (usually 25-30 kcal/kg/day). The target is reached in most patients by day 4.

Other advantages of a GI access in postoperative patients is the case with which fluids and electrolyte imbalances can be corrected and facility in administration of medications. Contraindications include hemodynamic instability requiring vasopressor support and intolerance (bloating, abdominal pain, peritonitis, diarrhea, and aspiration).

Early EN is safe in trauma, burns, hepato-biliary-pancreatic surgery, and esophageal/gastric surgery. It obviates the need for a feeding gastrostomy or jejunostomy. Early EN should be more widely practiced.


The 5th Congress of the PENSA
October 28-30 1999, Kuala Lumpur.
Page: 30