Current opinion in general surgery
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Improvements in surgical management and intensive care therapy have enabled many patients to initially survive severe life-threatening trauma or major surgical procedures only to die after delayed bouts of sepsis. This paper reviews literature published within the past year on the effects of nutrient substitution on malnutrition, injury, and the host immune response. Topics discussed include immunodeficiencies in trauma and malnutrition, immunomodulation by nutrition, and parenteral versus enteral nutrition. We also discuss the roles of arginine, glutamine, omega-3 fatty acids, and dietary nucleotides in the host immune response.
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Perioperative cardiac morbidity is the leading cause of death following the administration of general anesthesia. With the aging of the population, the number of patients at significant cardiac risk for noncardiac surgical procedures is expected approximately to double over the next 30 years. Assessing cardiac risk will assume increasing importance in surgical decisions. Historical predictors, diagnostic testing predictors, and recent data concerning preoperative cardiac physiology assessment and optimization are discussed.