Vol 2, No 2 (2021)

BACKGROUND: The efficiency of early oral feeding in the postoperative period is well known. Though doctors still prefer other types of nutritional support after esophagectomy with immediate gastric tube reconstruction in the esophagus surgery.

AIMS: To compare the efficacy, safety and nutritional status of patients after esophagectomy with gastric tube reconstruction while beginning of oral and full parenteral nutrition in the early postoperative period.

MATERIALS AND METHODS: We’ve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, anthropometric and laboratory indicators of the nutritional status before the operation on the first, third and sixth postoperative days.

RESULTS: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting early oral feeding on the first postoperative day and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 postoperative days. The patients of early oral feeding group had statistically significant earlier gas discharge(2 vs 4 postoperative days, р=0.000042) and stool appearance (3 vs 5 postoperative days, р=0.000004). There was a tendency towards a decrease in the duration of postoperative hospitalization in early oral feeding group (8 vs 9 postoperative days, р=0.13). Early oral feeding did not affect on frequency (46.6% vs 53.3%, р=0.66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on the third postoperative day in early oral feeding group (0.17 vs 0.2, р=0.03) of due to inability to compensate daily calorie needs in the first days after the operation. On the sixth postoperative day prealbumin became the same in both groups. There were no other significant differences between the groups.

CONCLUSIONS: Early oral feeding after esophagectomy with immediate gastric tube reconstruction is safe. Early oral feeding doesn’t increase the frequency of anastomotic insufficiency and other complications. The decrease of prealbumin on the third postoperative day was noted in early oral feeding group while evaluating nutritional status.

Oxygen is the main regulator of metabolic processes in the body not only in the context of normal physiology, but also in the development of various critical conditions.

In recent years, the problem of pathogenesis of a number organs' and systems' diseases has been enriched by knowledge of the mechanism of damage to cellular structures. Oxygen turned out to be the main factor of damage — the very oxygen, due to the lack of which cell death occurs. It turned out that the so-called reactive oxygen species having an unpaired electron have a biological effect, which, depending on the concentration, can be regulatory or, conversely, toxic. Accordingly, interest has also been aroused in compounds that normally prevent the toxic effect of reactive oxygen species — antioxidants. Today it is generally recognized that oxidative stress plays an important and possibly a key role in the pathogenesis of critical conditions. Thus, on the one side, excessive production of free radicals is considered as one of the manifestations of the body's protective reaction to the effects of various environmental factors and living conditions (infections, injuries, toxins, ionizing radiation, physical stress, hypothermia, hypoxia, various types of stress), on the other ― increased production of free radicals quickly leads to irreversible damage: destruction of the erythrocytes' membranes with subsequent hemolysis, transformation of hemoglobin into methemoglobin, DNA damage, desensitization of plasma membrane receptors, inactivation of various hormones and enzymes, including antiradical and antiperoxide protection enzymes.

The problem of using oxygen in critical conditions is currently widely discussed in the periodical literature with an emphasis on the oxygen concentrations used in patients, both in operating rooms and in intensive care units. Oxygen used in the intensive care of acute respiratory failure and hypoxia should have a certain concentration range. The toxic effects of oxygen can occur with its prolonged use in high concentrations, which causes not only its direct toxic effect on the lungs, but also in the potentiation of the activation of free radical oxidation and excessive production of reactive oxygen species.

The review presents current data on the physiological role of oxygen, its participation in metabolic processes against the background of inflammation, hypoxia and under conditions of activation of free radical oxidation processes. The recent approach to oxygen therapy and the research data presented in the review urge to relate to oxygen as a drug in order to avoid manifestations of its toxic effects.

A balanced diet and intake of high-protein specialized foods plays a key role in expanding the adaptive potential of athletes and affects the effectiveness of the training process. However, a diet composed of traditional food products may not always provide protein intake adequate to the high physiological needs of athletes, and therefore in some cases it is advisable to introduce high-protein specialized foods products.

Specialized products for athletes are subdivided, depending on the component composition and individual physiological needs of the athlete, taking into account sports specialization and the phase of the sports cycle, into high-protein, protein-carbohydrate, carbohydrate-protein, high-carbohydrate; carbohydrate-mineral drinks, isotonic, hypotonic, as well as biologically active food additives.

The article presents the basic principles of the use of specialized food products in the nutrition of athletes. A brief description of the protein components most commonly used in this product group is given. It has been shown that the intake of high-protein specialized food products that combine various types of proteins provides not only the maximum speed of recovery processes, but also stimulates anabolic reactions aimed at increasing muscle body mass, thereby affecting an increase in sports performance.

Biomedical rationale in the development of formulations of innovative specialized food products, the main component of which is protein, should be a leading factor in the use of raw materials and technical base for effective use in the training system of athletes.

Perioperative infusion support of surgical patients is the main and non-alternative element of treatment.

At the same time, the tactics of infusion therapy continues to be the subject of study. Ideas about the optimal quantitative and qualitative composition of the fluid transfused to patients are being revised as ideas about the pathogenesis of critical conditions evolve. The basis of pathogenetic analysis of compensatory hemodynamic capabilities, as a point of application of infusion treatment, previously consisted mainly of invasive monitoring techniques, replaced in recent years by the control of routine parameters with proven high correlation with invasive ones. In current studies devoted to the problems of infusion correction of hemodynamic abnormalities, the most discussed issues are the applicability of isotonic and balanced polyionic crystalloids, less often colloidal solutions in various clinical situations, and the results of such studies do not always allow to unambiguously determine the choice of infusion media, and sometimes simply incomparable. Some researchers advocate the use of isotonic crystalloids, some works prove the best effectiveness of balanced salt solutions. With the volumes of treatment corresponding to the perioperative period, in most studies there are no differences in the effectiveness of the main composite groups of crystalloids at all. We see the reason for this in the peculiarities of randomization methods, when statistical limitations do not allow us to avoid discrete data analysis: their comparative grouping occurs according to the principle of selecting a target parameter, and all the others are classified as auxiliary or secondary. It seems to us that the involvement of arrays of data obtained in real clinical practice as a result of a combination of local theoretical and empirical ideas about corrective treatment regimens correlated with their effectiveness could smooth out the inconsistency of the results of such studies, especially since clinicians have a sample with a volemic load at their disposal, allowing them to predict the hemodynamic reaction of the patient's body to infusion and a set of routine parameters for more fine-tuning of therapy.

In anesthesiological and resuscitation practice, there is an opinion of the currently popular empirical-evidence plan that balanced salt solutions are preferable to isotonic solutions with a higher degree of severity of patients, but this opinion is not a priori and requires additional research to verify the choice.