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    Pre- and Post-Surgery Health (Holistic)

    Pre- and Post-Surgery Health (Holistic)

    About This Condition

    The road to recovery starts with understanding what your body needs before, during, and after surgery. According to research or other evidence, the following self-care steps may be helpful.
    • Enjoy some ginger

      Reduce postoperative nausea and vomiting by taking 1 gram of encapsulated ginger powder 60 minutes before receiving general anesthesia

    • Think nutrition

      Eat a high-quality, balanced diet, and use nutritional supplements to prevent malnutrition that can impair recovery from surgery

    • Say good-bye to smoking

      Prevent poor surgery outcomes and many other health problems by kicking the habit for good

    About

    About This Condition

    Major surgery causes serious stress to the body. The body?s immune system is weakened and gastrointestinal function is changed after major surgery, leaving the body vulnerable to infection and in a state of nutritional insufficiency.1 Steps can be taken using natural approaches to strengthen the body before and after surgery, enhance defenses, prevent complications, and speed recovery.

    Healthy Lifestyle Tips

    Smoking compromises overall health and is associated with poorer outcomes of many types of surgery.2 , 3 , 4 Smoking may lessen the nausea and vomiting commonly experienced after surgery due to effects of anesthesia, according to a preliminary study,5 but the disadvantages far outweigh this single possible benefit.

    Holistic Options

    Acupressure can be used to prevent nausea and vomiting. Wristbands designed to apply pressure to acupuncture points on the forearm were shown to effectively prevent post-operative nausea and vomiting in seven controlled trials6 , 7 , 8 , 9 , 10 , 11 and were as effective as an antinausea medication in another.12 One controlled trial found no benefit from acupressure wristbands.13 Acupuncture 14 and transcutaneous electrical nerve stimulation (TENS) of a wrist acupuncture point15 have also been shown to be effective for post-operative nausea and vomiting in controlled trials. A controlled comparison study found that electroacupuncture of the wrist points controlled post-operative nausea and vomiting as well as antinausea medication and better than TENS, but both electro-acupuncture and TENS helped more than no treatment.16 A comprehensive review of research on acupuncture, electroacupuncture, TENS, acupoint stimulation, and acupressure for post-operative nausea and vomiting found these techniques to be more effective than placebo and as effective as commonly prescribed medications in adults but not in children.17 However, laser stimulation of the acupuncture points on the wrists both before and after surgery was effective for children in one controlled trial.18

    Eating Right

    The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

    Recommendation Why
    Think nutrition
    Eat a high-quality, balanced diet, and use nutritional supplements to prevent malnutrition that can impair recovery from surgery.

    Malnutrition, either before or after surgery, has a negative effect on recovery from surgery.19 , 20 , 21 , 22 , 23 Malnutrition is common among the elderly and chronically ill even in developed countries, and one study found that half of older general surgery patients had moderate to severe malnutrition from protein deficiency.24

    Being malnourished prior to surgery was associated with increased post-operative inflammation in one recent preliminary study.25 A study of patients requiring lung surgery found that those who were better nourished prior to surgery had shorter hospital stays and required less intensive post-surgery care.26 Dietary restriction and even fasting is often required prior to certain types of surgery. However, one study found that a four- to eight-day calorie-restricted diet lowered nutritional health and caused decreased immune system activity in pre-surgery patients, but adding a nutritional formula providing extra calories and protein reduced this negative effect of the restricted diet.27 In another study, the clear liquid diet commonly recommended to patients before colon surgery was compared with a liquid diet providing protein, calories, and other nutrients; the patients who received extra nutrition prior to surgery had shorter hospital stays than those who received only clear liquids.28 After reviewing animal and human studies comparing fasting and clear liquid pre-surgery diets to pre-surgery diets including liquid carbohydrate formulas, some authorities recommend a carbohydrate formula rather than fasting in preparation for surgery.29

    Liquid diets using specially prepared nutritional formulas containing all necessary nutrients are frequently used around the time of surgery, especially in patients who cannot eat solid food. Studies have also shown that use of nutritional formulas soon after surgery has a positive effect on recovery time after cesarean section30 and reduces rates of infection after abdominal surgeries.31 Reviews of nutrition research on all types of surgery patients have concluded that undernourished patients will have better results if they receive supplemental nutrition before and after surgery, and that supplemental nutrition is more helpful when given orally rather than directly to the bloodstream (intravenously).32 , 33 , 34 Whether people who are not malnourished benefit from these diet supplements is unknown.

    After major surgery, it is sometimes necessary to supply nourishment by a route that bypasses the digestive tract, such as intravenously, rather than by mouth. This form of nutrition is known as ?parenteral,? while food taken into the digestive tract is known as ?enteral.? While there is debate about whether parenteral nutrition is less healthful than enteral nutrition,35 the decision to use one or the other is a complicated one, and should be discussed in individual cases with the treating physician.

    Supplements

    What Are Star Ratings?

    Our proprietary ?Star-Rating? system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    Supplement Why
    3 Stars
    Glutamine
    20 grams daily
    Studies have shown that using glutamine-enriched formulas after surgery increased immune cell activity, shortened hospital stays, improved nutritional status, and reduced infections.

    Glutamine , one of the most abundant amino acids in the body, supports the health of the cells lining the gastrointestinal tract and is important for immune function.36 Glutamine is depleted when the body is under stress, including the stress of surgery.37 Blood levels of glutamine decrease following surgery, and as they return to normal, their increase parallels the increase in immune cells.38 Two controlled trials have shown that the use of glutamine-enriched intravenous formulas, providing approximately 20 grams of glutamine per day, resulted in increased immune cell activity and shorter hospital stays.39 , 40 Double-blind studies report that patients receiving intravenous formulas supplemented with glutamine after surgery had better nutritional status and better health outcomes, including fewer infections and other complications, compared with patients receiving regular formulas.41 , 42

    2 Stars
    Arginine
    12.5 to 18.75 grams daily before and after surgery
    The amino acid arginine has a role in immune function, infection prevention, and tissue repair after injury, including surgery.

    The amino acid arginine has a role in immune function, infection prevention, and tissue repair after injury, including surgery.43 Animal research suggests that supplemental arginine may improve the outcomes in cardiovascular44 and colon surgeries.45 Other animal studies suggest a possible role for arginine in prevention of adhesions, a painful type of internal scarring that can occur with surgery.46 Human trials of formulas including arginine are discussed below, but the benefits of supplemental arginine alone have not been studied in surgery patients.

    2 Stars
    Fish Oil
    3.3 to 5 grams daily omega-3 fatty acids before and after surgery
    Omega-3 fatty acids, found in fish oil, have anti-inflammatory properties and may improve recovery and prevent infection after surgery.

    Omega-3 fatty acids have anti-inflammatory properties,47 and animal studies suggest that supplementation with omega-3 fatty acids may improve recovery and prevent infection after surgery.48 , 49 A controlled human trial found that intravenous nutritional formulas containing omega-3 fatty acids given post-operatively lowered the production of inflammatory chemicals compared with standard nutritional formulas.50 Other human studies of omega-3 fatty acid-supplemented nutritional formulas used in surgery patients have included other supplemental nutrients as well and are discussed below.51

    2 Stars
    Ginger
    1 gram of powder in a capsule 60 minutes before receiving general anesthesia (inform your anesthesiologist)
    Ginger has antinausea properties and may prevent postoperative nausea and vomiting.

    A recent study found that 24% of surgery patients had taken herbal supplements before their surgeries, and 50 different herbs had been used among these patients.52 Little research exists, however, on the safety or efficacy of herbs before surgery. Some researchers and healthcare providers are concerned about possible harmful interactions between herbs and medications used around or during surgery, or the possibility that some herbs may increase bleeding during and after surgery.53 , 54 The use of herbs around the time of surgery should be discussed with a knowledgeable healthcare practitioner.

    Nausea and vomiting can be experienced post-operatively as a result of anesthesia. Ginger (Zingiber officinale) has antinausea properties and has been examined for its ability to prevent post-operative nausea and vomiting in several controlled trials. In two of these controlled trials, ginger was found more effective than placebo and equal to an antinausea medication;55 , 56 however, in two other controlled trials ginger was not found to have any benefit.57 , 58 A review considering the results of these trials concluded that 1 gram of ginger taken before surgery prevents nausea and vomiting slightly better than placebo, but this difference is not significant.59 However, a more recent review concluded that ginger is an effective means for reducing postoperative nausea and vomiting.60

    2 Stars
    Iron
    Consult a qualified healthcare practitioner
    Iron supplementation prior to surgery was found in one trial to reduce the need for postoperative blood transfusions.

    One preliminary study found iron levels to be reduced after both minor and major surgeries, and iron supplementation prior to surgery was not able to prevent this reduction.61 A controlled trial found that intravenous iron was more effective than oral iron for restoring normal iron levels after spinal surgery in children.62 One animal study reported that supplementation with fructo-oligosaccharides (FOS) improved the absorption of iron and prevented anemia after surgery,63 but no human trials have been done to confirm this finding. Some researchers speculate that iron deficiency after a trauma such as surgery is an important mechanism for avoiding infection, and they suggest that iron supplements should not be given after surgery.64

    Patients who have undergone major surgery frequently need blood transfusions to replace blood lost during the procedure. Studies have found that 18 to 21% of surgery patients were anemic prior to surgery,65 , 66 and these anemic patients required more blood after surgery than did non-anemic surgery patients. Supplementation with iron prior to surgery was found in a controlled trial to reduce the need for blood transfusions, whether or not iron deficiency was present.67 Iron supplements (99 mg per day) given before and for two months after joint surgery in another controlled trial improved blood values but did not change the length of hospitalization or the risk of post-operative fever.68 Pre-operative iron supplementation in combination with a medication that stimulates red blood cell production in the bone marrow is considered by some doctors to be an effective way to minimize the need for post-operative blood transfusions.69

    2 Stars
    Ribonucleic Acid
    1.2 to 1.8 grams daily before and after surgery
    During times of physical stress, such as surgery, ribonucleic acid (RNA) helps stimulate immune cell division and activity and is needed in greater amounts.

    Ribonucleic acid (RNA) is a member of the nucleotide family of biomolecules and supports protein synthesis and cell growth. During times of physical stress, RNA helps stimulate immune cell division and activity,70 , 71 and is needed in greater amounts. Animal studies show that nucleotides given in the diet support the immune response and decrease death rates in infected animals.72 , 73 , 74 In human infants, those fed nucleotide-enriched formulas have healthier gastrointestinal systems and better immune function than do those fed ordinary formulas.75 , 76 , 77 RNA is included in some oral and intravenous nutritional formulas used for surgery patients, and these formulas are discussed below.

    2 Stars
    Taurine
    Take at least 1.5 grams daily before and after surgery
    Taurine is an amino acid that appears to have an important role in immune cell functions. Supplementing with it may reduce inflammation.

    Taurine is an amino acid abundantly present in the body that also appears to have an important role in immune cell functions.78 A preliminary trial found that patients receiving an oral formula enriched with taurine (1 gram per liter) beginning two days before surgery and continuing until five days after surgery had less inflammation after surgery compared with those receiving a standard formula.79

    2 Stars
    Vitamin C (Vitamin C Deficiency)
    100 to 250 mg once or twice per day
    Vitamin C supports immune function and is a critical nutrient for wound healing. Supplementing with it may decrease the risk of excessive bleeding in the surgical setting.

    Vitamin C deficiency can be detrimental to immune function in hospitalized patients,80 and one study found that half of surgery patients recovering at home had low dietary intakes of vitamin C.81 Vitamin C is also a critical nutrient for wound healing ,82 , 83 but studies of vitamin C supplementation have shown only minor effects on the healing of surgical wounds.84 , 85 Vitamin C deficiency also can increase the risk of excessive bleeding in the surgical setting.86

    1 Star
    Alpha Ketoglutarate (AKG)
    Refer to label instructions
    AKG is used by cells during growth and in healing from injuries and other wounds, and is especially important in the healing of muscle tissue.

    AKG (alpha-ketoglutarate) is used by cells during growth and in healing from injuries and other wounds ,87 and is especially important in the healing of muscle tissue.88 Controlled studies have found intravenous AKG helpful for supporting protein synthesis, which often declines as a result of surgery, and for protecting the heart muscle from damage during heart surgery,89 but no research has investigated whether oral AKG would be similarly effective.

    1 Star
    Fructo-oligosaccharides
    Refer to label instructions
    Supplementing with fructo-oligosaccharides (FOS) appears to improve iron absorption and restore iron levels, which may be reduced after surgery.

    One preliminary study found iron levels to be reduced after both minor and major surgeries, and iron supplementation prior to surgery was not able to prevent this reduction.90 A controlled trial found that intravenous iron was more effective than oral iron for restoring normal iron levels after spinal surgery in children.91 One animal study reported that supplementation with fructo-oligosaccharides (FOS) improved the absorption of iron and prevented anemia after surgery,92 but no human trials have been done to confirm this finding. Some researchers speculate that iron deficiency after a trauma such as surgery is an important mechanism for avoiding infection, and they suggest that iron supplements should not be given after surgery.93

    1 Star
    Selenium
    Refer to label instructions
    Selenium has an important role in immune function and infection prevention, and supplementing with it may correct a postoperative selenium deficiency.

    Selenium is a mineral nutrient with an important role in immune function and infection prevention,94 , 95 , 96 and selenium deficiency has been reported in patients after intestinal surgery.97 A controlled trial of critically ill patients, including some with recent major surgery, found that those receiving daily intravenous selenium injections for three weeks showed less biochemical signs of body stress compared with unsupplemented patients. The amount used in this trial was 500 mcg twice daily for the first week, 500 mcg once daily for the second week, and 100 mcg three times daily for the third week.98

    1 Star
    Turmeric
    Refer to label instructions
    Turmeric has anti-inflammatory effects. One trial found curcumin (from turmeric) was more effective than anti-inflammatory medication for relieving postsurgical inflammation.

    A recent study found that 24% of surgery patients had taken herbal supplements before their surgeries, and 50 different herbs had been used among these patients.99 Little research exists, however, on the safety or efficacy of herbs before surgery. Some researchers and healthcare providers are concerned about possible harmful interactions between herbs and medications used around or during surgery, or the possibility that some herbs may increase bleeding during and after surgery.100 , 101 The use of herbs around the time of surgery should be discussed with a knowledgeable healthcare practitioner.

    Turmeric (Curcuma longa) is an herb with anti-inflammatory effects.102 One trial found curcumin (from turmeric) at 400 mg three times daily was more effective than either placebo or anti-inflammatory medication for relieving post-surgical inflammation. However, as the different treatment groups had different degrees of inflammation at the start of the study, firm conclusions cannot be drawn from this study.103

    1 Star
    Vitamin A
    Refer to label instructions
    Topical vitamin A may help speed wound healing and reduce scarring in patients taking corticosteroids, which typically slow wound healing.

    Vitamin A plays an important role in wound healing ,104 and one animal study suggests that vitamin A deficiency might contribute to poor recovery after surgery.105 Vitamin A may be particularly beneficial to post-surgical patients who are using corticosteroid medications. These medications typically slow wound healing, and a number of animal studies have found that both topical and oral vitamin A reverse this effect; however, vitamin A does not change healing time in animals not given corticosteroids.106 , 107 , 108 Similar results have been reported for topical vitamin A in some human cases, and these researchers suggest a topical preparation containing 200,000 IU of vitamin A per ounce for improved surgical wound healing in patients using corticosteroids after surgery.109 Topical vitamin A may also reduce scarring in patients taking corticosteroids.110

    1 Star
    Vitamin B1
    Refer to label instructions
    Vitamin B1, given as intramuscular injections before surgery, resulted in less reduction of immune system activity after surgery in one study.

    Vitamin B1 , given as intramuscular injections of 120 mg daily for several days before surgery, resulted in less reduction of immune system activity after surgery in a preliminary trial.111 In a controlled trial, an oral B vitamin combination providing 100 mg of B1, 200 mg of vitamin B6 , and 200 mcg of vitamin B12 daily given for five weeks before surgery and for two weeks following surgery also prevented post-surgical reductions in immune activity.112 However, no research has explored any other benefits of B vitamin supplementation in surgery patients.

    1 Star
    Vitamin B12
    Refer to label instructions
    In one trial, a combination of vitamins B1, B6, and B12 before and after surgery prevented post-surgical reductions in immune activity.

    Vitamin B1 , given as intramuscular injections of 120 mg daily for several days before surgery, resulted in less reduction of immune system activity after surgery in a preliminary trial.113 In a controlled trial, an oral B vitamin combination providing 100 mg of B1, 200 mg of vitamin B6 , and 200 mcg of vitamin B12 daily given for five weeks before surgery and for two weeks following surgery also prevented post-surgical reductions in immune activity.114 However, no research has explored any other benefits of B vitamin supplementation in surgery patients.

    1 Star
    Vitamin B6
    Refer to label instructions
    In one trial, a combination of vitamins B1, B6, and B12 before and after surgery prevented post-surgical reductions in immune activity.

    Vitamin B1 , given as intramuscular injections of 120 mg daily for several days before surgery, resulted in less reduction of immune system activity after surgery in a preliminary trial.115 In a controlled trial, an oral B vitamin combination providing 100 mg of B1, 200 mg of vitamin B6 , and 200 mcg of vitamin B12 daily given for five weeks before surgery and for two weeks following surgery also prevented post-surgical reductions in immune activity.116 However, no research has explored any other benefits of B vitamin supplementation in surgery patients.

    1 Star
    Vitamin E
    Refer to label instructions
    Some studies have found that vitamin E levels decrease after surgery, supplementation may correct a deficiency. Vitamin E may also prevent scarring when used topically after surgery.

    Some studies of surgery patients,117 , 118 though not all, 119 have found that blood levels of vitamin E decrease during and after surgery. Animal research suggests that vitamin E may prevent skin scarring when used topically after surgery,120 but a human study reported disappointing results.121 Vitamin E taken by mouth may interfere with blood clotting122; therefore, use of vitamin E before surgery should be discussed with the surgeon. No research on either the usefulness or hazards of vitamin E supplementation around surgery has been done.

    1 Star
    Zinc
    Refer to label instructions
    Zinc is important for proper immune system function and wound healing. Zinc supplements taken before surgery may prevent zinc deficiency and promote healing.

    Zinc is a mineral nutrient important for proper immune system function and wound healing.123 One study found most surgery patients recovering at home had low dietary intakes of zinc.124 Low blood levels of zinc have been reported in patients after lung surgery.125 , 126 In one study this deficiency lasted for up to seven days after surgery and was associated with higher risk of pneumonia,127 while another study found an association between post-operative zinc deficiency and fatigue.128 Poor post-operative wound healing is also more common in people with zinc deficiency.129 Zinc supplements given to patients before surgery prevented zinc deficiency in one study, but the effect of these supplements on post-surgical health was not evaluated.130

    References

    1. O?Flaherty L, Bouchier-Hayes DJ. Immunonutrition and surgical practice. Proc Nutr Soc 1999;58:831?7 [review].

    2. McGowan N. Surgery and smoking. Semin Perioper Nurs 1999;8:146?54 [review].

    3. Crews KM, Cobb GW, Seago D, Williams N. Tobacco and dental implants. Gen Dent 1999;47:484?8 [review].

    4. Chung F, Mezei G, Tong D. Pre-existing medical conditions as predictors of adverse events in day-case surgery. Br J Anaesth 1999;83:262?70.

    5. Chimbira W, Sweeney BP. The effect of smoking on postoperative nausea and vomiting. Anaesthesia 2000;55:540?4.

    6. Harmon D, Ryan M, Kelly A, Bowen M. Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. Br J Anaesth 2000;84:463?7.

    7. Harmon D, Gardiner J, Harrison R, Kelly A. Acupressure and the prevention of nausea and vomiting after laparoscopy. Br J Anaesth 1999;82:387?90.

    8. Alkaissi A, Stalnert M, Kalman S. Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery. Acta Anaesthesiol Scand 1999;43:270?4.

    9. Gieron C, Wieland B, von der Laage D, Tolksdorf W. Acupressure in the prevention of postoperative nausea and vomiting. Anaesthesist 1993;42:221?6 [in German].

    10. Ho CM, Hseu SS, Tsai SK, Lee TY. Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-cesarean section pain relief. Acta Anaesthesiol Scand 1996;40:372?5.

    11. Fan CF, Tanhui E, Joshi S, et al. Acupressure treatment for prevention of postoperative nausea and vomiting. Anesth Analg 1997;84:821?5.

    12. Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesth Analg 1997;84:342?5.

    13. Agarwal A, Pathak A, Gaur A. Acupressure wristbands do not prevent postoperative nausea and vomiting after urological endoscopic surgery. Can J Anaesth 2000;47:319?24.

    14. al-Sadi M, Newman B, Julious SA. Acupuncture in the prevention of postoperative nausea and vomiting. Anaesthesia 1997;52:658?61.

    15. Fassoulaki A, Papilas K, Sarantopoulos C, Zotou M. Transcutaneous electrical nerve stimulation reduces the incidence of vomiting after hysterectomy. Anesth Analg 1993;76:1012?4.

    16. Ho RT, Jawan B, Fung ST, et al. Electro-acupuncture and postoperative emesis. Anaesthesia 1989;45:327?9.

    17. Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999;88:1362?9 [review].

    18. Schlager A, Offer T, Baldissera I. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery. Br J Anaesth 1998;81:529?32.

    19. O?Flaherty L, Bouchier-Hayes DJ. Immunonutrition and surgical practice. Proc Nutr Soc 1999;58:831?7 [review].

    20. Silk DB, Green CJ. Perioperative nutrition: parenteral versus enteral. Curr Opin Clin Nutr Metab Care 1998;1:21?7 [review].

    21. Reiland KE. Gastrointestinal surgical patients? outcomes influenced by nutrition. AORN J 2000;71:199?200, 203?4 [review].

    22. Petit J, Kaeffer N, Dechelotte P, Oksenhendler G. Respective indications of enteral or parenteral nutrition during pre- and post-operative periods. Ann Fr Anesth Reanim 1995;14 suppl 2:127?36 [review, in French].

    23. Mazzotta MY. Nutrition and wound healing. J Am Podiatr Med Assoc 1994;84:456?62 [review].

    24. Stotts NA, Whitney JD. Nutritional intake and status of clients in the home with open surgical wounds. J Community Health Nurs 1990;7:77?86.

    25. Nakamura K, Moriyama Y, Kariyazono H, et al. Influence of preoperative nutritional state on inflammatory response after surgery. Nutrition 1999;15:834?41.

    26. Mazolewski P, Turner JF, Baker M, et al. The impact of nutritional status on the outcome of lung volume reduction surgery: a prospective study. Chest 1999;116:693?6.

    27. Montanari M, Violi V, De Bernardinis M, et al. Efficacy of a low-residue diet in the prevention of immuno-nutritional changes caused by the preparation of the colon for surgery. Chir Ital 1988;40:23?8 [in Italian].

    28. Rumley TO, Lineaweaver WC, Davis JM. Low residue nutritional supplementation as an adjunct to mechanical preparation for surgical treatment of the colon. Surg Gynecol Obstet 1987;164:345?50.

    29. Hessov I, Ljungqvist O. Preoperative oral nutrition. Curr Opin Clin Nutr Metab Care 1998;1:29?33 [review].

    30. Soriano D, Dulitzki M, Keidar N, et al. Early oral feeding after cesarean delivery. Obstet Gynecol 1996;87:1006?8.

    31. Singh G, Ram RP, Khanna SK. Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. J Am Coll Surg 1998;187:142?6.

    32. Silk DB, Green CJ. Perioperative nutrition: parenteral versus enteral. Curr Opin Clin Nutr Metab Care 1998;1:21?7 [review].

    33. Petit J, Kaeffer N, Dechelotte P, Oksenhendler G. Respective indications of enteral or parenteral nutrition during pre- and post-operative periods. Ann Fr Anesth Reanim 1995;14 suppl 2:127?36 [review, in French].

    34. Reiland KE. Gastrointestinal surgical patients? outcomes influenced by nutrition. AORN J 2000;71:199?200, 203?4 [review].

    35. Reiland KE. Gastrointestinal surgical patients? outcomes influenced by nutrition. AORN J 2000;71:199?200, 203?4 [review].

    36. Campos FG, Waitzberg DL, Logulo AF, et al. The role of glutamine in nutrition in clinical practice. Arq Gastroenterol 1996;33:86?92 [review, in Portugese].

    37. O?Flaherty L, Bouchier-Hayes DJ. Immunonutrition and surgical practice. Proc Nutr Soc 1999;58:831?7 [review].

    38. Greig JE, Keast D, Garcia-Webb P, Crawford P. Inter-relationships between glutamine and other biochemical and immunological changes after major vascular surgery. Br J Biomed Sci 1996;53:116?21.

    39. Morlion BJ, Stehle P, Wachtler P, et al. Total parenteral nutrition with glutamine dipeptide after major abdominal surgery: a randomized, double-blind, controlled study. Ann Surg 1998;227:302?8.

    40. O?Riordain MG, De Beaux A, Fearon KC. Effect of glutamine on immune function in the surgical patient. Nutrition 1996;12:S82?4.

    41. Jian ZM, Cao JD, Zhu XG, et al. The impact of alanyl-glutamine on clinical safety, nitrogen balance, intestinal permeability, and clinical outcome in postoperative patients: a randomized, double-blind, controlled study of 120 patients. JPEN J Parenter Enteral Nutr 1999;23:S62?6.

    42. Morais AA, Santos JE, Faintuch J. Comparative study of arginine and glutamine supplements in malnourished surgical patients. Rev Hosp Clin Fac Med Sao Paulo 1995;50:276?9 [in Portugese].

    43. Evoy D, Lieberman MD, Fahey TJ 3rd, Daly JM. Immunonutrition: the role of arginine. Nutrition 1998;14:611?7 [review].

    44. Szabo G, Bahrle S, Batkai S, et al. L-arginine: effect on reperfusion injury after heart transplantation. World J Surg 1998;22:791?7.

    45. Shashidharan M, Lin KM, Ternent CA, et al. Influence of arginine dietary supplementation on healing colonic anastomosis in the rat. Dis Colon Rectum 1999;42:1613?7.

    46. Kaleli B, Ozden A, Aybek Z, Bostanci B. The effect of L-arginine and pentoxifylline on postoperative adhesion formation. Acta Obstet Gynecol Scand 1998;77:377?80.

    47. Gerster H. The use of n-3 PUFAs (fish oil) in enteral nutrition. Int J Vitam Nutr Res 1995;65:3?20 [review].

    48. Kollman KA, Lien EL, Vanderhoof JA. Dietary lipids influence intestinal adaptation after massive bowel resection. J Pediatr Gastroenterol Nutr 1999;28:41?5.

    49. Johnson JA 3d, Griswold JA, Muakkassa FF. Essential fatty acids influence survival in sepsis. J Trauma 1993;35:128?31.

    50. Wachtler P, Konig W, Senkal M, et al. Influence of a total parenteral nutrition enriched with omega-3 fatty acids on leukotriene synthesis of peripheral leukocytes and systemic cytokine levels in patients with major surgery. J Trauma 1997;42:191?8.

    51. Gianotti L, Braga M, Fortis C, et al. A prospective, randomized clinical trial on perioperative feeding with an arginine-, omega-3 fatty acid-, and RNA-enriched enteral diet: effect on host response and nutritional status. JPEN J Parenter Enteral Nutr 1999;23:314?20.

    52. Norred CL, Zamudio S, Palmer SK. Use of complementary and alternative medicines by surgical patients. AANA J 2000;68:13?8.

    53. Murphy JM. Preoperative considerations with herbal medicines. AORN J 1999;69:173?5, 177?8, 180?3.

    54. Robb-Nicholson C. By the way, doctor. My surgeon advised me to stop taking gingko biloba before my hip surgery. Can you explain why? Are there any other herbs I should avoid? Harv Womens Health Watch 2000;7:8.

    55. Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (ginger)?an antiemetic for day case surgery. Anaesthesia 1993;48:715?7.

    56. Bone ME, Wilkinson DJ, Young JR, et al. Ginger root?a new antiemetic. The effect of ginger root on the postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia 1990;45:669?71.

    57. Visalyaputra S, Petchpaisit N, Somcharoen K, Choavaratana R. The efficacy of ginger root in the prevention of postoperative nausea and vomiting after outpatient gynaecological laparoscopy. Anaesthesia 1998;53:506?10.

    58. Arfeen Z, Owen H, Plummer JL, et al. A double-blind randomized controlled trial of ginger for the prevention of postoperative nausea and vomiting. Anaesth Intensive Care 1995;23:449?52.

    59. Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth 2000;84:367?71 [review].

    60. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, et al. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol2006;194:95?9.

    61. van Iperen CE, Kraaijenhagen RJ, Biesma DH, et al. Iron metabolism and erythropoiesis after surgery. Br J Surg 1998;85:41?5.

    62. Berniere J, Dehullu JP, Gall O, Murat I. Intravenous iron in the treatment of postoperative anemia in surgery of the spine in infants and adolescents. Rev Chir Orthop Reparatrice Appar Mot 1998;84:319?22 [in French].

    63. Ohta A, Ohtsuki M, Uehara M, et al. Dietary fructo-oligosaccharides prevent postgastrectomy anemia and osteopenia in rats. J Nutr 1998;128:485?90.

    64. Mainous MR, Deitch EA. Nutrition and infection. Surg Clin North Am 1994;74:659?76 [review].

    65. Andrews CM, Lane DW, Bradley JG. Iron pre-load for major joint replacement. Transfus Med 1997;7:281?6.

    66. Goodnough LT, Vizmeg K, Sobecks R, et al. Prevalence and classification of anemia in elective orthopedic surgery patients: implications for blood conservation programs. Vox Sang 1992;63:90?5.

    67. Andrews CM, Lane DW, Bradley JG. Iron pre-load for major joint replacement. Transfus Med 1997;7:281?6.

    68. Guinea JM, Lafuente P, Mendizabal A, et al. Results of preoperative autotransfusion with ferrous ascorbate prophylaxis in orthopedic surgery patients. Sangre (Barc) 1996;41:25?8 [in Spanish].

    69. Tasaki T, Ohto H, Motoki R. Pharmacological approaches to reduce perioperative transfusion requirements in the aged. Drugs Aging 1995;6:91?104 [review].

    70. Rudolph FB, Van Buren CT. The metabolic effects of enterally administered ribonucleic acids. Curr Opin Clin Nutr Metab Care 1998;1:527?30 [review].

    71. Kulkarni AD, Rudolph FB, Van Buren CT. The role of dietary sources of nucleotides in immune function: a review. J Nutr 1994;124:1442S?6S [review].

    72. Jyonouchi H, Sun S. An orally supplemented mononucleotide mixture prevents the decrease in T cell-dependent humoral immunity in C57BL/6 mice fed a nucleotide-free diet. J Nutr 1996;126:1586?93.

    73. Carver JD. Dietary nucleotides: effects on the immune and gastrointestinal systems. Acta Paediatr Suppl 1999;88:83?8 [review].

    74. Carver JD. Dietary nucleotides: cellular immune, intestinal and hepatic system effects. J Nutr 1994;124:144S?8S [review].

    75. Carver JD. Dietary nucleotides: effects on the immune and gastrointestinal systems. Acta Paediatr Suppl 1999;88:83?8 [review].

    76. Cosgrove M. Perinatal and infant nutrition. Nucleotides. Nutrition 1998;14:748?51 [review].

    77. Carver JD. Dietary nucleotides: cellular immune, intestinal and hepatic system effects. J Nutr 1994;124:144S?8S [review].

    78. Redmond HP, Stapleton PP, Neary P, Bouchier-Hayes D. Immunonutrition: the role of taurine. Nutrition 1998;14:599?604 [review].

    79. O?Flaherty L, Bouchier-Hayes DJ. Immunonutrition and surgical practice. Proc Nutr Soc 1999;58:831?7 [review].

    80. Dowd PS, Kelleher J, Walker BE, Guillou PJ. Nutrition and cellular immunity in hospital patients. Br J Nutr 1986;55:515?27.

    81. Stotts NA, Whitney JD. Nutritional intake and status of clients in the home with open surgical wounds. J Community Health Nurs 1990;7:77?86.

    82. Thomas DR. Specific nutritional factors in wound healing. Adv Wound Care 1997;10:40?3 [review].

    83. Wendt MD, Soparkar CN, Louie K, et al. Ascorbate stimulates type I and type III collagen in human Tenon?s fibroblasts. J Glaucoma 1997;6:402?7.

    84. Vaxman F, Olender S, Lambert A, et al. Effect of pantothenic acid and ascorbic acid supplementation on human skin wound healing process. A double-blind, prospective and randomized trial. Eur Surg Res 1995;27:158?66.

    85. Vaxman F, Olender S, Lambert A, et al. Can the wound healing process be improved by vitamin supplementation? Experimental study on humans. Eur Surg Res 1996;28:306?14.

    86. Blee TH, Cogbill TH, Lambert PJ. Hemorrhage associated with vitamin C deficiency in surgical patients. Surgery 2002;131:408?12.

    87. Aussel C, Coudray-Lucas C, Lasnier E, et al. Alpha-Ketoglutarate uptake in human fibroblasts. Cell Biol Int 1996;20:359?63.

    88. Wernerman J, Hammarqvist F, Vinnars E. Alpha-ketoglutarate and postoperative muscle catabolism. Lancet1990;335:701?3.

    89. Kjellman UW, Bjork K, Ekroth R, et al. Addition of alpha-ketoglutarate to blood cardioplegia improves cardioprotection. Ann Thorac Surg 1997;63:1625?33.

    90. van Iperen CE, Kraaijenhagen RJ, Biesma DH, et al. Iron metabolism and erythropoiesis after surgery. Br J Surg 1998;85:41?5.

    91. Berniere J, Dehullu JP, Gall O, Murat I. Intravenous iron in the treatment of postoperative anemia in surgery of the spine in infants and adolescents. Rev Chir Orthop Reparatrice Appar Mot 1998;84:319?22 [in French].

    92. Ohta A, Ohtsuki M, Uehara M, et al. Dietary fructo-oligosaccharides prevent postgastrectomy anemia and osteopenia in rats. J Nutr 1998;128:485?90.

    93. Mainous MR, Deitch EA. Nutrition and infection. Surg Clin North Am 1994;74:659?76 [review].

    94. McKenzie RC, Rafferty TS, Beckett GJ. Selenium: an essential element for immune function. Immunol Today 1998;19:342?5 [review].

    95. Hughes DA. Effects of dietary antioxidants on the immune function of middle-aged adults. Proc Nutr Soc 1999;58:79?84 [review].

    96. Lesourd BM. Nutrition and immunity in the elderly: modification of immune responses with nutritional treatments. Am J Clin Nutr 1997;66:478S?84S [review].

    97. Gjorup I, Gjorup T, Andersen B. Serum selenium and zinc concentrations in morbid obesity. Comparison of controls and patients with jejunoileal bypass. Scand J Gastroenterol 1988;23:1250?2.

    98. Lehmann C, Egerer K, Weber M, et al. Effect of selenium administration on various laboratory parameters of patients at risk for sepsis syndrome. Med Klin 1997;92:14?6 [in German].

    99. Norred CL, Zamudio S, Palmer SK. Use of complementary and alternative medicines by surgical patients. AANA J 2000;68:13?8.

    100. Murphy JM. Preoperative considerations with herbal medicines. AORN J 1999;69:173?5, 177?8, 180?3.

    101. Robb-Nicholson C. By the way, doctor. My surgeon advised me to stop taking gingko biloba before my hip surgery. Can you explain why? Are there any other herbs I should avoid? Harv Womens Health Watch 2000;7:8.

    102. Arora RB, Basu N, Kapoor V, Jain AP. Anti-inflammatory studies on Curcuma longa (turmeric). Indian J Med Res 1971;59:1289?95.

    103. Satoskar RR, Shah SJ, Shenoy SG. Evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. Int J Clin Pharmacol Ther Toxicol 1986;24:651?4.

    104. Mazzotta MY. Nutrition and wound healing. J Am Podiatr Med Assoc 1994;84:456?62 [review].

    105. Swartz-Basile DA, Rubin DC, Levin MS. Vitamin A status modulates intestinal adaptation after partial small bowel resection. JPEN J Parenter Enteral Nutr 2000;24:81?8.

    106. Ehrlich H, Hunt TK. Effects of cortisone and vitamin A on wound healing. Ann Surg 1968;167:324?8.

    107. Hunt TK, Ehrlich HP, Garcia JA, Dunphy JE. Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man. Ann Surg 1969;170:633?40.

    108. Ehrlich HP, Tarver H, Hunt TK. Effects of vitamin A and glucocorticoids upon inflammation and collagen synthesis. Ann Surg 1973;177:222?7.

    109. Hunt TK, Ehrlich HP, Garcia JA, Dunphy JE. Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man. Ann Surg 1969;170:633?40.

    110. Hunt TK. Vitamin A and wound healing. J Am Acad Dermatol 1986;15:817?21.

    111. Vinogradov VV, Tarasov IuA, Tishin VS, et al. Thiamin prevention of the corticosteroid reaction after surgery. Probl Endokrinol 1981;27:11?6 [in Russian].

    112. Lettko M, Meuer S. Vitamin B-induced prevention of stress-related immunosuppression. Ann NY Acad Sci 1990;585:513?5.

    113. Vinogradov VV, Tarasov IuA, Tishin VS, et al. Thiamin prevention of the corticosteroid reaction after surgery. Probl Endokrinol 1981;27:11?6 [in Russian].

    114. Lettko M, Meuer S. Vitamin B-induced prevention of stress-related immunosuppression. Ann NY Acad Sci 1990;585:513?5.

    115. Vinogradov VV, Tarasov IuA, Tishin VS, et al. Thiamin prevention of the corticosteroid reaction after surgery. Probl Endokrinol 1981;27:11?6 [in Russian].

    116. Lettko M, Meuer S. Vitamin B-induced prevention of stress-related immunosuppression. Ann NY Acad Sci 1990;585:513?5.

    117. Zunic J, Stavljenic-Rukavina A, Granic P, et al. Changes in vitamin E concentration after surgery and anesthesia. Coll Antropol 1997;21:327?34.

    118. Kawamura T, Ohisa Y, Abe Y, et al. Plasma lipid peroxides in the operation of esophageal cancer. Rinsho Byori 1992;40:881?4 [in Japanese].

    119. Hans P, Canivet JL, Pincemail J, et al. Plasma vitamin E, total lipids and myeloperoxidase levels during spinal surgery. A comparison between two anesthetic agents: propofol and isoflurane. Acta Anaesthesiol Scand 1991;35:302?5.

    120. Greenwald DP. Zone II flexor tendon repair: effects of vitamins A, E and beta-carotene. J Surg Res 1990;49:98?102.

    121. Jenkins M, Alexander W, MacMillan BG. Failure of topical steroids and vitamin E to reduce post-operative scar formation following reconstructive surgery. J Burn Care Rehab 1986;7:309?12.

    122. Anastasi J, Steiner M. Effect of alpha-tocopherol on human platelet aggregation. Am J Clin Nutr 1976;29:467 [abstract].

    123. Thomas DR. Specific nutritional factors in wound healing. Adv Wound Care 1997;10:40?3 [review].

    124. Stotts NA, Whitney JD. Nutritional intake and status of clients in the home with open surgical wounds. J Community Health Nurs 1990;7:77?86.

    125. Yamamoto R, Inoue K, Hori T, et al. Clinical evaluation of changes in serum zinc and copper concentrations around pulmonary operation. Nippon Kyobu Geka Gakkai Zasshi 1994;42:1178?83 [in Japanese].

    126. Cordova Martinez A, Escanero Marcen JF. Changes in serum trace elements after surgery: value of copper and zinc in predicting post-operative fatigue. J Int Med Res 1992;20:12?9.

    127. Yamamoto R, Inoue K, Hori T, et al. Clinical evaluation of changes in serum zinc and copper concentrations around pulmonary operation. Nippon Kyobu Geka Gakkai Zasshi 1994;42:1178?83 [in Japanese].

    128. Cordova Martinez A, Escanero Marcen JF. Changes in serum trace elements after surgery: value of copper and zinc in predicting post-operative fatigue. J Int Med Res 1992;20:12?9.

    129. Senapati A, Slavin BM, Thompson RPH. Zinc depletion and complications of surgery. Clinical Nutrition 1990;9:341?6.

    130. Hallbook T, Hedelin H. Pre-operative peroral zinc supplementation. Acta Chir Scand 1978;144:63?6.

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