Nutritional supplements and surgical patients

The effects of protease supplementation on skeletal muscle function and DOMS following downhill running

Protease supplementation has been shown to attenuate soft tissue injury resulting from intense exercise. The aim of this study was to evaluate the effects of protease supplementation on muscle soreness and contractile performance after downhill running. Ten matched pairs of male participants ran at a -10% grade for 30 min at 80% of their predicted maximal heart rate. The participants consumed two protease tablets (325 mg pancreatic enzymes, 75 mg trypsin, 50 mg papain, 50 mg bromelain, 10 mg amylase, 10 mg lipase, 10 mg lysozyme, 2 mg chymotrypisn) or a placebo four times a day beginning 1 day before exercise and lasting a total of 4 days. The participants were evaluated for perceived muscle soreness of the front and back of the dominant leg, pressure pain threshold by dolorimetry of the anterior medial, anterior lateral, posterior medial and posterior lateral quadrants of the thigh, and knee extension/flexion torque and power. The experimental group demonstrated superior recovery of contractile function and diminished effects of delayed-onset muscle soreness after downhill running when compared with the placebo group. Our results indicate that protease supplementation may attenuate muscle soreness after downhill running. Protease supplementation may also facilitate muscle healing and allow for faster restoration of contractile function after intense exercise.

Nutritional support

Despite the increasing obesity of the American population, many chronically ill patients are malnourished. When this malnutrition is combined with the hypermetabolic response and protein catabolism of an acute event, such as an operation, nutritional support becomes an important facet for optimal critical care. This chapter reviews the basic tenants of nutritional support with special emphasis on patients with pulmonary compromise. Important aspects of caloric and protein support are discussed and enteral nutrition is emphasized because of its numerous advantages and documented improvement in outcome.

Preoperative assessment criteria and patient teaching for ambulatory surgery patients

Today's trend is to have the surgical patient return to the comfort of his or her home rather than be admitted to the hospital for expensive nursing and medical care. The perioperative team must initially assess the patient's American Society of Anesthesiology status, anxiety level, food and drugs to which he or she may be allergic, and skin integrity; obtain a medical and surgical history and consent; review laboratory, electrocardiogram, and radiological results; and perform preoperative teaching (e.g., which medications to take or withhold preoperatively, when to withhold food and fluids) and postoperative teaching (e.g., catheter care, dressing changes). In addition, the nurse needs to anticipate and be prepared for medical emergencies such as airway management problems and malignant hyperthermia. The age of the patient (e.g., pediatric and geriatric age groups) and preoperative disease states and their severity also need to be recognized as they impact on the perioperative outcome. The assessment phase is one of the most important phases in the perioperative experience. Proper evaluation is the key to success for positive surgical outcomes. Given the time constraints in the ambulatory surgical setting, assessing and teaching the patient on the day of surgery is not feasible or appropriate. Reaching out to the patient a few days before surgery either in the patient's home, in the ambulatory surgery center, or by telephone is the ultimate goal.