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Peri-operative amino acid administration and the metabolic response to surgery

Published online by Cambridge University Press:  28 July 2008

Eva Selldén
Eva Selldén*
Affiliation:
Department of Anaesthesia and Intensive Care, Karolinska Hospital, S-171 76 Stockholm, Sweden
*
*Corresponding author: Dr Eva Selldén, fax +46 8 30 77 95, email eva.sellden@ks.se
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Abstract

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General anaesthesia causes hypothermia due to decreased metabolic rate and impaired thermoregulation. Many warming devices are in use to prevent heat loss, but little attention has been paid to stimulating the body's own heat generation. All nutrients raise energy expenditure, and the highest thermic effect is ascribed to amino acids and proteins, 30–40% in the awake state. Amino acids infused during general anaesthesia exert a thermic effect that is enhanced compared with that in the awake state. At awakening from anaesthesia, post-operative hypothermia may be prevented without shivering. The tissues involved and the mechanisms by which nutrients stimulate heat production are still not completely understood. However, these findings support the existence of an inhibitory action normally exerted by central thermosensors, in order to maintain oxidative metabolism within certain limits, to prevent hyperthermia. During anaesthesia central thermosensors are silenced and, hence, amino acid thermogenesis is exaggerated. The amino acid-induced heat generation during anaesthesia predominantly occurs in extra-splanchnic tissues, most probably in skeletal muscle. It may reflect an increased protein turnover, as both protein breakdown and synthesis are energy-consuming processes known to generate heat. Possibly, amino acid infusion provides substrates, otherwise mobilized from the body's own tissues, needed for wound healing and immunological function. However, other cellular mechanisms may also contribute to this non-shivering thermogenesis.

Keywords

AnaesthesiaMetabolismAmino acid infusionHypothermiaThermogenesis
Type
Joint National Nurses Nutritional Group and Parenteral and Enteral Group of the British Dietetic Association Symposium on ‘Working in Partnership’
Information
Proceedings of the Nutrition Society , Volume 61 , Issue 3 , August 2002 , pp. 337 - 343
Copyright
Copyright © The Nutrition Society 2002

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