Post-Surgical Nutritional Management in Dogs and Cats

Presenter Suraj Subedi Roll no. 29 B. V. V. Sc. & A. H., 9th sem 1

Care of the surgical patient does not end when the procedure is finished. Postoperative care of surgical patients often

determines

th e

ultimate

outcome; with critical patients it may determine whether they survive. 2

Patients Outcome in relation to 3 different aspects of surgery

Postoperative Manageme nt

Patients Outcome Preoperative Manageme nt

Surgical procedure 3

Postsurgical Pos tsurgical Management Management  Normalization

y

of Homeostasis

y

Control of Pain

y

Prevention of Secondary Infection

y

Early Recognition of Complications

 Nutritional

y

Management 4

Nutritional

Managementt Managemen

Patient Requirement

Feeding Route

Proper Nutrition of Post surgical patients 5

Calorie y

Requirements

Basal Energy Requirement (BER)

y

Animal

less than 2 kg body wt.

y

Animal

more than 2 kg body wt.

6

y

Maintenance Energy Requirements (MER)

Associated Clinical Problems

Factor

Cage Rest

1.00 1.00  1.25

Postsurgical Stress

1.25  1.3 1.35

Trauma or o r Cancer

1.3 1.35  1.5 1.5

Sepsis

1.50  1.70

Major Burns

1.70  2.00 7

Protein Prot ein Requirements

Species

Maintenance

Hepatic or Renal failu failure re

Canine

5.0  7. 7.5 g/100 kcal

< 3.0 g/100 kcal

Feline

6.0  9.0 g/100 kcal

< 4.0 g/100 kcal

8

How

the nutrients are provided??? Nutrients

Enteral Nutrition

Normal  Voluntary 

Parenteral

Hyperalimentation 9

Parenteral Nutrition y

Pro Provision of the the readily utilized nut nutrie rients in the their sim simple plest form orm tha that a body can utilize.

y

Rout Ro utee is the the slo slow con onti tinu nuou ouss infu infusi sion on thro throug ugh h cath cathet eter er i/v i/v.

y

Indicated when intestine cannot adequately absorb nutrients (severe malabsor sorpti ption, impai paired motility, massiv sive small bowel resect resection ion etc.) etc.)

y

8.5% amino acids with electrolytes (protein source), 10 to 20% lipid pids (fat) and 50% 50% dext extrose ( carboh ohyydrate) are gener nerally used. B-c B-comple plex are added at 1-2 ml per per ltr. tr. 10

Com ommon mon y

Paren Par ente terral Inf Infusio usions ns

Hermin Hermin T (Alembic) (Alembic)

y

 Aminodrip  Aminodrip (Wockhar (Wockhardt) dt)

y

 Aminosteril-N Hepa 8% (Fresenius (Fresenius Kabi)

y

Intralipid Intralipid (F (Fres resenius enius Kabi)

y

Dextrose 50%

11

Complications

of Parenter arenteral al Nutrition

y

Catheter kinking and displacement

y

Phlebitis

y

Thrombosis

y

Sepsis

y

Hyperglycemia

y

Hyperlipidemia

y

y

 Azotemia Electrolyte imbalance 12

Ent nter eral al y

Rout oute e of nut nutrit rition ion

Ideal enteral diet sho should be well toler oleraated, readily digeste sted and absorbed, contain essential nutrients, be readily  available, inexpensive, have a long shelf life and easy to use.

y

die diets shou should ld be iso isoton onic ic (ap (appro prox. 300 mOsm mOsm//L)

y

loricc den densit sity of app approx. 1.0 1.0 kcal/m l/ml Calori

y

Include fib fiber at 1.0 to 1.5 g/100 kcal and

y

pro provide vide appr appro ox 16% of total calories as protein and approx 30% of calories as fat. 13

Types

of Enter eral al Di Die ets

 A. Monomeric y

y

y

y

Indi Indica catted in pati patien ents ts with with Gast Gastrroi oint ntest estin inal al disor disorde ders rs cryst crystal alli line ne amin amino o acid acidss for for prot protei ein n gluc glucose ose and and olig oligosac osacch chari arides des as carbo carbohy hydr drat atee safflo safflow wer oi oill as esse ssentia ntiall fat fatty acids ids sour sourcce

B. Polymeric y

y

indicated for patients with intact digestive and absorptiv absorptivee function function contain large molecular weight proteins, carbo carbohy hydr drat ates es and and fats. fats. 14

Some y

Polymeric Diets y

y

y

commercial diets commercial

 Jev  Jevit ityy Osmo Osmoli litte HN Impact

y

 Vital HN

y

ProMod

Monomer onomeric ic Diets Diets y

Vinonex HN 15

A

homemade diet

For dog and cat y

y

y

y

y

1 jar baby food 1 cooked egg 15 ml corn oil 15 ml corn syrup 100 ml water

Nutrient : 1 kcal/ml

16

Enteral Hyperalimentaion y

Designate supplying of the nutrients by methods like y

Nasoesophageal

y

Pharyngostomy 

y

Esophagostomy 

y

Gastrotomy 

y

Enterostomy 

17

Naso asoeso esoph phag agea eall y

y

intu in tuba bati tion on

Smal Smalll bor bore soft soft pol polyvin yvinyl and and sila silast stic ic feedi eedin ng tube tubess  Well  Well tolerat tolerated ed

y

Can be left for several days

y

Can drink and swallow around the tubes avoiding

repeat repeated ed intub intubati ation. on. y

Liqu Liquid id diet diet admi admini nist ster ered ed

y

Cats and Dogs < 15 kg wt. : 5 French X 91 cm

Dogs > 15 kg wt. : 8 French X 91 cm 18

19

Pharyngostomy y

ontr trai aind ndic icat ated ed for for pati patien ents ts with with esop esopha hag geal diso disorrders ders Con (

i.e.

esophagitis,

esophageal

stricture,

recent

esop esoph hagea ageall sur surgery, ry, eso esophag phagea eall forei oreign gn bod body remov moval, al, neoplasm). y

Larg Larger diam diamet eter er gen. en. 20  24 French.

y

Plac Placed ed upt upto the the mide mideso soph phag agus us

20

Esophagostomy y

Lar Large bor bore tube tubess 20  24 French

y

Elim Elimin inat ates es coug oughing hing,, lary laryng ngos ospa pasm sm,, and/ and/or or aspi aspirratio ation n occa oc casi sion onal allly asso associ ciat ated ed with with laryn laryng gost ostomy omy tube tubess.

y

Disadvantage: need for general anesthesia for tube placement

21

22

Gastrotomy y

Ease of patience, patients tolerance

y

Large bore size

y

Oral feeding can commence normally 

y

Disadvantage: y

Need for specialized instrument

y

General anesthesia

y

  Waiti Waiting ng for 12  24 hrs before initiating feeding 23

24

25

Enterostomy y

y

y

Celio eliottomy omy is requi equirred for plac placem emen entt of thes thesee tube tubess

 A 5French , 36 inch infa infan nt needl eedlee used sed High Highly ly dig digesti estibl blee foo ood d mat materia erials ls are are supp suppli lied ed

26

27

Rate and Volume of Feeding y

Depends upon the state of patient and capacity of intestine

y

Normal canine and feline feline capacity:

y

80

ml fluid/ kg b. wt.

 Anorectic Patients: 30 ± 40 cc f luid/kg b. wt. and gradual increase over 2-3 days.

y

 A minimum of  3 feedings daily  28

Guidelines

for feeding via an Ent nter erost ostom omy y tub tube e

y

Calculate total requirement

y

Give ¼ of calculated volume during first 24 hrs

y

Give ½ of calculated vol. during second 24 hrs

y

Give ¾ of calculated cal culated volume during third t hird 24 hrs

y

Give entire calculated volume during fourth fo urth 24 hours

y

Note: a minimum of  4-5 feedings /day needed. 29

omplications tions Complica y

of enteral enteral hyper hyperaliment alimentation ation

Mechanical y

inadvertent tube placement in trachea or peritoneal cavity 

y

gut perforation

y

regur regurgita gitaion ion in tube

y

Irritation

y

infection at exit site

y

Occlusion

y

tube removal 30

y

Gastrointestinal y

y

 Vomiting

y

Cramping

y

abdominal distension

y

diarrhoea

Metabolic complica complications tions y

Hyperg Hypergly lycae caemia mia (major) (major)

y

Hypophosphatemia

y

hyperkalemia 31

References M. J. 1998 998. Current Techniques in Small Animal Surgery, 4 th edition, Williams & Wilkins, US A

y

Bojrab,

y

Denise, A.

E. Parenteral Nutrition.  In http://www.vin.com/proceedings/Proceedings http://www.vin.com/proceedings/Proceedings.plx? .plx? CID=WSAVA2004&Category=1252&O=Generic Accessed on 24th may, 2011

y

Denise , A.

E. Home Made Diets  In http://www.vin.com/proceedings/Proceedings http://www.vin.com/proceedings/Proceedings.plx?CI .plx?CID=WSAVA200 4&Category=1252&O=Generic Accessed on 24th may, 2011

y

Fossum.,T.

y

Pierson, A. L. Feeding tubes for Cats  In www.catinfo.org accessed on 25th may, 2011

W. 1997. Small Animal Surgery. 1st Mosby, USA

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Thank Yo You 33

Questions uestions are highly welcomed welcomed

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