this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons , the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery .
The prescription of these recommendations can accelerate the postoperative recovery of patients su bmi tted to elective general surgery , with decrease in morbidity , length of stay and rehospitalization , and consequently , of costs
OBJECTIVE to present recommendations based on the ACERTO Project ( Acceleration of Total Post-Operative Recovery ) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures .
Oral carbohydrate loading with 18% carbohydrate beverage alleviates insulin resistance.
Preoperative 12.6 % oral carbohydrate loading is an element of the Enhanced Recovery After Surgery ( ERAS ) protocol aim ed at alleviating postoperative insulin resistance ; however , in Japan , beverages with 18 % carbohydrate content are generally used for preoperative carbohydrate loading . We investigated the effect of 18 % carbohydrate loading on alleviating insulin resistance .  Six healthy volunteers participated in this crossover-r and omized study and were segregated into 2 groups : volunteers in the carbohydrate-loading group ( group A ) who fasted from after 9 pm and ingested 375 mL of a beverage containing 18 % carbohydrate ( ArginaidWaterTM ; Nestle , Tokyo , Japan ) between 9 pm and 12 pm , and 250 mL of the same liquid at 6:30 am . Volunteers in control group ( group B ) drank only water . At 8:30 am , a hyperinsulinemic normoglycemic clamp was initiated . Glucose infusion rate ( GIR ) and levels of ketone bodies and cytokines ( IL-1β , IL-6 , and TNF-α ) before clamping were evaluated . p<0.05 was considered statistically significant . Levels of blood glucose , insulin , and cytokines at the start of the clamp were similar in both the groups . The GIR in group A was significantly higher than that in group B ( 11.5±2.4 vs 6.2±2.2 mg/kg/min , p=0.005 ) , while blood ketone body levels were significantly lower in group A ( 22±4 vs 124±119 μmol/L , p=0.04 ) . Preoperative 18 % carbohydrate loading could prevent the decrease in insulin sensitivity and suppress catabolism in healthy volunteers .  Thus , carbohydrate loading with a beverage with 18 % carbohydrate content might contribute to improvements in perioperative management
this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons , the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery .
The prescription of these recommendations can accelerate the postoperative recovery of patients su bmi tted to elective general surgery , with decrease in morbidity , length of stay and rehospitalization , and consequently , of costs
OBJECTIVE to present recommendations based on the ACERTO Project ( Acceleration of Total Post-Operative Recovery ) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures .