1.
Prehabilitation: metabolic considerations.
Chabot, K, Gillis, C, Carli, F
Current opinion in clinical nutrition and metabolic care. 2020;(4):271-276
Abstract
PURPOSE OF REVIEW The major components of ERAS attenuate the inflammatory response and modulate metabolism in direction of sparing body protein and preserving function. However, these perioperative interventions might have limited effectiveness on postoperative outcomes if preoperative risk factors are not addressed and optimized. RECENT FINDINGS The preoperative metabolic perturbations characterized by insulin resistance and sarcopenia might predispose patients to a higher degree of postoperative catabolism. High-risk populations for such metabolic disturbances include elderly and frail patients, and patients with metabolic syndrome. Research on the effect of prehabilitation on perioperative metabolism is limited, but recent findings suggest that interventions designed to improve insulin sensitivity prior to surgery might represent a promising therapeutic target to minimize surgical complications. SUMMARY The present paper will discuss the metabolic implications of modulating preoperative risk factors with elements of multimodal prehabilitation, such as exercise training and nutrition.
2.
[Preoperative preparation of pregnant with hypertension according to state of the autonomic nervous system and circulatory system].
Gur'ianov, VA, Tolmachev, GN, Volodin, AV, Marichik, NV, NemirovskiÄ, VB, Pivovarova, GM, Shepetovskaia, NL
Anesteziologiia i reanimatologiia. 2010;(6):7-12
Abstract
Pregnancy in patients with hypertension is considered in the spotlight of creation of general adaptation syndrome. According to evidence, when a stable hypertension in pregnant patients with hyper- and eukinetic types of haemodynamics is observed, the response of circulatory system and body fluid compartments has a moderate difference with normal. In pregnant patients with hypertension and a hypokinetic type of haemodynamics and pregnant patients with gestosis developed against the background of eukinetic type of hypertension, a physiological decrease of total peripheral resistance (TPR) is absent, which contributes into interstitial hyperhydration. In pregnant patients with gestosis developed against the background of hypokinetic type of haemodynamics, a pathological rise of TPR occurs, which is followed with a more significant interstitial hyperhydration. A differentiated preoperative preparation of pregnant with hypertension with the calcium antagonists and hydroxyethyl starch solution (130/0,4) favours the conversion of hyper- and hypokinetic types of haemodynamics to eukinetic, forms a physiological type of sympathicotonia and improves the water-salt metabolism.
3.
[Calcium antagonists in the preoperative preparation of pregnant women with gestosis].
Shepetovskaia, NL, Piovarova, GM, Gur'ianov, VA, Tolmachev, GN, Volodin, AV
Anesteziologiia i reanimatologiia. 2007;(6):20-4
Abstract
Differential preoperative preparation of pregnant women with gestosis, which is aimed at eliminating dysfunction of the universal secondary calcium messenger and preventing further disorders caused by calcium antagonists, is accompanied by positive changes in the basic links of development of the general adaptation syndrome--the autonomic nervous and cardiovascular systems. A physiologically required reduction in total peripheral vascular resistance (TPVE) is achieved in pregnant women with hyper- and eukinetic hemodynamics. In pregnant women with hypokinetic type, who receive hydroxyethyl starch-130/04 solution in the infusion therapy protocol, there is elimination of its pathological increase and there is a tendency for its physiological reduction. Obviating the discrepancy between cardiac index and TPVE causes a change of the hyper- and hypokinetic hemodynamic types to the eukinetic one, which is attended by development of physiological sympathicotonia and by almost complete normalization of water metabolic parameters in pregnant women with gestosis.