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"Malnutrisi energi dan protein merupakan suatu masalah umum yang ditemukan pada pasien rawat inap di rumah sakit. Berbagai studi menunjukkan sebanyak 40% pasien bedah sudah mengalami malnutrisi pada saat masuk ke rumah sakit. Studi tersebut menunjukkan terdapat hubungan langsung antara penurunan berat badan pra bedah dengan laju mortalitas pasca bedah. Terapi nutrisi perioperatif yang adekuat telah dilaporkan dapat menurunkan laju morbiditas dan menurunkan masa rawat inap secara bermakna. Serial kasus ini terdiri atas empat kasus terapi nutrisi perioperatif pada pasien malnutrisi dengan kanker periampular yang menjalani pembedahan pankreatikoduodenektomi. Pasien adalah laki-laki, berusia antara 40-60 tahun, dengan kanker periampular (pankreas dan ampula Vateri). Keempat pasien kasus ini mengalami sindrom kaheksia-kanker, yaitu ditemukan penurunan BB sebesar 10-15% dalam ena bulan terakhir, anemia, fatigue, dan hipoalbuminemia. Kebutuhan energi total dihitung dengan menggunakan persamaan Harris-Bennedict dengan menambahkan faktor stres sebesar 1,5. Pemberian kalori dan nutrisi dilakukan secara bertahap dan ditingkatkan sesuai dengan perbaikan keadaan klinis, gastrointestinal, dan toleransi asupan pasien. Pemantauan dan evaluasi pasien dilakukan sesuai dengan perubahan subyektif dan obyektif. Selain itu, konseling dan edukasi mengenai terapi nutrisi diberikan setiap hari pada pasien. Selama perawatan, keempat pasien serial kasus ini menunjukkan perbaikan, baik secara subyektif maupun obyektif. Kebutuhan energi total tercapai selama periode pra bedah dan tujuh hingga sembilan hari pasca bedah. Masa rawat pasien ini adalah 12-20 hari. Perbaikan status nutrisi tidak tercapai pada pasien ini, namun terjadi perbaikan kapasitas fungsional dan proses penyembuhan luka yang adekuat. Terapi nutrisi perioperatif yang diberikan diharapkan mampu meningkatkan atau mempertahankan status nutrisi pasien, prognosis pasca bedah, serta meningkatkan kapasitas fungsional dan kualitas hidup pasien secara keseluruhan.

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Energy and protein malnutrition are common issues in hospitalized patient worldwide. Various studies had reported that 40% of surgical patient were already malnutrition when admitted to the hospital. The study reported that there were direct relationships between lost of body weight with mortality rate post surgery. Adequate perioperative nutritional therapy had been reported could decrease the morbidity rate and length of stay significantly. This case series consist of four perioperative nutritional management cases in malnourished patients with periampullary cancer that undergone pancreaticoduodenectomy surgery. Patients were male, age between 40-60 years, with periampullary cancer (pancreas & ampulla of Vatery). This four patients were having cancer-cahexia syndrome, which was characterized by lost of body weight 10-15% in the last six months, anemia, fatigue, and hypoalbuminemia. Total energy requirement were calculated with Harris-Bennedict equation with stress factor equal to 1,5. Energy and nutrition were given gradually and increased according to the improvement of clinical & gastrointestinal condition, and food intake tolerance of the patients. Monitoring and evaluation of the patients were applied according to the changes of subjective and objective parameter. Besides that, counseling and education were also given everyday to all of the patients. During the hospitalization, this four case series patients showed improvement, in both subjective and objective parameter. Total energy requirement was achieved in preoperative periode and seven until nine days postoperative in all of this patients. Length of stay of this patients were 12-20 days. Improvement of nutritional status were not found in this patients, but there were significant improvement of functional capacity and wound healing happened in them. Perioperative nutritional management applied to the patients were expected could increase or maintain the patiens’ nutritional status, improve prognosis post surgery functional capacity, and eventually leads to improvement of overall quality of life of the patients."

"Sabiston Textbook of Surgery is your ultimate foundation for confident surgical decision making. Covering the very latest science and data affecting your treatment planning, this esteemed medical reference helps you make the most informed choices so you can ensure the best outcome for every patient."-- Publisher's website."

"This handbook is aimed at first-line health care providers involved in the perioperative care of adult and pediatric neurosurgical patients. It is unique in its systematic focus on how to deal with common and important clinical challenges encountered in day-to-day practice in the OR, the PACU, and the ICU and is designed as a problem-solving tool for all members of the perioperative medicine team: trainees and faculty in anesthesiology, neurosurgery, and critical care; nurses; nurse anesthetists; and physician’s assistants. • Encompasses clinical continuum from neurosurgical pre-op to critical care – plus anesthesia in neuroradiology• Adult and pediatric care• Structured algorithmic approach supports clinical decision-making• Succinct presentation of clinically relevant basic science• End-of-chapter summaries, with suggestions for further reading• Collaborative approach and multidisciplinary nature of perioperative medicine emphasized• Extensive summary tables• Portable and formatted for quick retrieval of information• Ideal for use in the OR, the PACU, and the ICU"

"Manual of fast track recovery for colorectal surgery provides a broad overview on enhanced recovery, with expert opinions from leaders in the field regarding elements of enhanced recovery care that are generic and specific to colorectal surgery. This book covers the patient journey through such a programme, commencing with optimisation of the patient’s condition, patient education and conditioning of their expectations. Manual of fast track recovery for colorectal surgery investigates the metabolic response to surgery, anaesthetic contributions and optimal fluid management, after surgery. It also details examples of enhanced recovery pathways and practical tips on post-operative pain control, feeding, mobilisation and criteria for discharge."

"Surgery needs skill. Skill needs knowledge. Knowledge of tricks, moves, and tools. This book is about such knowledge. Expert authors have contributed technical pearls, gained by years of experience. The short “how-I-do-it” chapters offer the reader a quick and effective guide that will be invaluable when addressing any penetrating injury. The book is not intended to serve as a comprehensive volume of pathophysiology and management in trauma; rather the goal is to provide practical solutions on how to treat injuries surgically. It describes the steps that you must take when, in the middle of the night, confronted with devastating bleeding, you will have only one chance to save a life."

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