Liver Functions, Stress and Hemodynamic Responses to Parenteral Lipid Emulsions in Cancer Patients Undergoing GIT Surgery;A Comparative Study between SMOFlipid and Intralipid

Background: Surgery elicits profound changes in the neuroendocrine, metabolic, and immune systems, which constitute the “stress response” which have been implicated in the development of postoperative complications such as infection. There is a delicate balance between the release of pro and anti-inflammatory cytokines. An exaggerated proinflammatory response, i.e. systemic inflammatory response (SIRS) may lead to hemodynamic decompensation and multi-organ failure (MOF).Patients and Methods: The present study included 40 patients divided to two groups, group A: including 20 patients receiving the traditional intralipid emulsion, and group B: including 20 patients receiving the new omega-3 SMOFlipid 20% lipid emulsion. The Subjective Global Assessment method of nutrition (class B and C) is used as screening test to select patients in the study which takes into consideration body weight, dietary intake, GIT symptoms. In all patients parenteral nutrition support was started at day 1 to provide 25-30 kcal/kg/d and 1-1.5g protein/kg/d, at least for 7 days post operative. 30-40% of non protein caloric intake was provided from lipid emulsions. All patients received perioperative fluids, electrolytes, trace elements, micronutrients, prophylactic antibiotics, and deep venous thrombosis and stress ulcer prophylaxis as clinically prescribed.Parameters measured in the study were total leucocytic count, liver functions (ALT AST and albumin), blood sugar, heart rate, respiratory rate, arterial blood pressure and body temperature.Results: Total leucocytic count (TLC) showed statistically significant decrease in day 7 postoperatively in SMOFlipid group. Liver function tests regarding albumin and liver enzymes showed different results; albumen in day 7 was statistical difference between the two groups but ALT AST showed no statistical difference Blood sugar results showed non significant difference in day 7 postoperatively between both groups. Clinical parameters including blood pressure, heart rate (HR), respiratory rate (RR) and temperature showed variety of results. RR was significantly decreased in SMOFlipid group but blood pressure, HR and temperature showed non significant difference between two groups.Conclusion: This study demonstrates that SMOFlipid is clinically safe and well tolerated in postoperative patients and associated with less stress response and infection rate.