[Indication and practical aspects of perioperative parenteral nutrition].

By means of the present clinical findings it is demonstrated that an improvement of the preoperative nutritional status goes along with a reduction of the postoperative rates of mortality and complications. The effects of postoperative catabolism compared with chronic protein losses are shown. It is demonstrated that acute catabolism is essentially at the cost of viscerally synthesized and functionally important protein systems whereas chronic states of catabolism mainly affect the structural protein of the overall organism. This differentiation appears to be of importance in selecting the perioperative nutritional treatment. It must be distinguished between a specific protein replacement therapy in cases of acute protein losses and a calorically adequate parenteral nutrition in chronic deficiency states and calorie deficits. On the basis of our own findings these conceptions are illustrated, and practical hints for performing the infusion therapy are given.