TPN AND SURGERY
Patients who receive TPN often require surgical procedures. Metabolic abnormalities are relatively common, and, ideally, should be corrected preop-eratively. For example, hypophosphatemia is a seri-ous and often unrecognized complication that can contribute to postoperative muscle weakness and respiratory failure.
When TPN infusions are suddenly stopped or decreased perioperatively, hypoglycemia may develop. Frequent measurements of blood glucose concentration are therefore required in such instances during general anesthesia. Conversely, if the TPN solution is continued unchanged, excessive hyperglycemia resulting in hyperosmolar nonke-totic coma or ketoacidosis (in patients with diabe-tes) is also possible. The neuroendocrine stress response to surgery frequently aggravates glucose intolerance. Regardless of whether the TPN infusion is continued, reduced, replaced with10% dextrose, or stopped, blood glucose monitoring will be needed during all but short, minor surgical procedures.