POSTOPERATIVE METABOLIC PATTERNS FOLLOWING IMMEDIATE TOTAL NUTRITIONAL SUPPORT - HORMONE LEVELS, DNA-SYNTHESIS, NITROGEN-BALANCE, AND ACCELERATED WOUND-HEALING

Dogs with a standardized bowel resection and efficient exclusion of swallowed air tolerated enteral feedings of an elemental diet at rates sufficient to produce marked positive N balance within minutes of surgery. Patients with efficient esophagogastric aspiration of swallowed air also tolerated immediate enteral feeding of this solution and enter positive N balance. Both patients and beagles respond to hyperalimentation with a markedly elevated insulin level. In the dog this corresponded to a marked increase in postoperative oxidative glucose consumption. In the beagles, hyperalimentation was noted to cause increased albumin and globulin synthesis within 24 h of bowel resection. DNA synthesis in the bowel wound of the fed beagle at 72 h was 6.2 times that when the subject was not fed. The bursting pressures of the unsupported abdominal wall wound and the still-sutured bowel wound 96 h postoperatively in the fed beagle were quadruple and triple, respectively, the pressure required for disruption without hyperalimentation. Earlier provision of full nutrition postoperatively may be of clinical benefit, even to the previously well-nourished patient.