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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

References

Aksnes, A-K, Brundin, T, Hjeltnes, N, Maehlum, S & Wahren, J (1993) Meal-induced rise in resting energy expenditure in patients with complete cervical spinal cord lesions. Paraplegia 31, 462–472.Google ScholarPubMed
Aksnes, A-K, Brundin, T, Hjeltnes, N & Wahren, J (1994) Glucose-induced thermogenesis in tetraplegic patients with low sympatho-adrenal activity. American Journal of Physiology 266, E161–E170.Google Scholar
Aksnes, A-K, Brundin, T & Wahren, J (1995) Metabolic, thermal and circulatory effects of intravenous infusion of amino acids in tetraplegic patients with complete spinal cord lesions. Clinical Physiology 15, 377–396.CrossRefGoogle Scholar
Berne, C, Fagius, J & Niklasson, F (1989) Sympathetic response to oral carbohydrate administration. Evidence from microelectrode recordings. Journal of Clinical Investigation 84, 1403–1409.CrossRefGoogle Scholar
Brismar, B, Hedenstierna, G, Lundh, R & Tocics, L (1982) Oxygen uptake, plasma catecholamines and cardiac output during neurolept-nitrous oxide and halothane anaesthesias. Acta Anaesthesiologica Scandinavica 26, 541–549.CrossRefGoogle ScholarPubMed
Brundin, T (1997) Glucose versus amino acids: splanchnic and totalVO2 and blood flow. In Physiology, Stress and Malnutrition: Functional Correlates, Nutritional Intervention, pp. 251–274 [Kinney, JM and Tucker, HN, editors]. New York: Lippincott-Raven.Google Scholar
Brundin, T (1998) Whole body and splanchnic metabolic, circulatory, and thermal effects of oral vs. intravenous fat administration. American Journal of Physiology 274, E684–E691.Google ScholarPubMed
Brundin, T, ThöRne, A & Wahren, J (1992) Heat leakage across the abdominal wall and meal-induced thermogenesis in normal-weight and obese subjects. Metabolism 41, 49–55.CrossRefGoogle ScholarPubMed
Brundin, T & Wahren, J (1994) Changes in splanchnic and whole-body oxygen consumption, blood flow and blood temperature in response to intravenous administration of amino acids. American Journal of Physiology 266, E396–E402.Google Scholar
Clark, M, Colquhoun, E, Rattigan, S, Dora, K, Eldershaw, T, Hall, J & Ye, J-M (1995) Vascular and endocrine control of muscle metabolism. American Journal of Physiology 268, E797–E812.Google ScholarPubMed
Downey, JA, Mottram, RF & Pickering, GW (1964) The location by regional cooling of central temperature receptors in the conscious rabbit. American Journal of Physiology 170, 415–441.CrossRefGoogle ScholarPubMed
Eisenman, JS (1974) Depression of preoptic thermosensitivity by bacterial pyrogen in rabbits. Journal of Applied Physiology 227, 1067–1073.Google ScholarPubMed
EsséN, P, Mcnurlan, M, Sonnenfeldt, T, Milne, E, Vinnars, E, Wernerman, J & Garlick, P (1993) Muscle protein synthesis after operation: effects of intravenous nutrition. European Journal of Surgery 159, 195–200.Google ScholarPubMed
Fagius, J & Berne, C (1994) Increase in muscle nerve sympatheticactivity in humans after food intake. Clinical Science 86, 159–167.CrossRefGoogle Scholar
Felig, P (1975) Amino acid metabolism in man. Annual Review of Biochemistry 44, 933–955.CrossRefGoogle ScholarPubMed
Frank, S, Fleisher, L, Breslow, M, Higgins, M, Olsson, K, Kelly, S & Beattie, C (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. Journal of the American Medical Association 277, 1127–1134.CrossRefGoogle ScholarPubMed
Frank, SM, Fleisher, LA, Olson, KF, Gorman, RB, Higgins, MS, Breslow, M, Sitzman, JV & Beattle, C (1995) Multivariate determinates of early postoperative oxygen consumption: the effects of shivering, core temperature, and gender. Anesthesiology 83, 241–249.CrossRefGoogle ScholarPubMed
Giovannini, I, Chiarla, C, Boldrini, G, Castiglioni, GC & Castagneto, M (1988) Calorimetric response to amino acid infusion in sepsis and critical illness. Critical Care Medicine 16, 667–670.CrossRefGoogle ScholarPubMed
Hammarqvist, F, Wernerman, J, Ali, R, Von Der Decken, A & Vinnars, E (1989) Addition of glutamine to total parenteral nutrition after elective abdominal surgery spares free glutamine in muscle, counteracts the fall in muscle protein synthesis, and improves nitrogen balance. Annals of Surgery 209, 455–461.CrossRefGoogle ScholarPubMed
Hersio, K, Takala, J, Kari, A & Huttunen, H (1991) Changes in whole body and tissue oxygen consumption during recovery from hypothermia: effect of amino acid infusion. Critical Care Medicine 19, 503–508.CrossRefGoogle ScholarPubMed
Horwath, S, Sparr, G, Hutt, B & Hamilton, L (1956) Metabolic cost of shivering. Journal of Applied Physiology 8, 595–602.CrossRefGoogle Scholar
JéQuier, E (1986) The influence of nutrient administration on energy expenditure in man. Clinical Nutrition 5, 181–186.CrossRefGoogle ScholarPubMed
Jezek, P & Garlid, KD (1998) Mammalian mitochondrial uncoupling proteins. International Journal of Biochemistry and Cellullar Biology 30, 1163–1168.CrossRefGoogle ScholarPubMed
Joris, J, Ozaki, M, Sessler, DI, Hardy, AF, Lamy, M, Mcguire, J, Blanchard, D, Schroeder, M & Moayeri, A (1994) Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia. Anesthesiology 80, 268–277.CrossRefGoogle ScholarPubMed
Kurz, A, Sessler, DI & Lenhardt, R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. New England Journal of Medicine 334, 1209–1215.CrossRefGoogle ScholarPubMed
Kurz, A, Sessler, DI & Narzt, E (1995) Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. Journal of Clinical Anesthesia 7, 359–366.CrossRefGoogle ScholarPubMed
Landsberg, L & Young, JB (1978) Fasting, feeding and regulation of the sympathetic nervous system. New England Journal of Medicine 298, 1295–1301.CrossRefGoogle ScholarPubMed
Leslie, K & Solly, M (1995) Brain protection during neurosurgery: an update from the anesthetist's perspective. Journal of Clinical Neuroscience 2, 285–294.CrossRefGoogle Scholar
Lowell, BB & Spiegelman, BM (2000) Towards a molecular understanding of adaptive thermogenesis. Nature 404, 652–660.CrossRefGoogle ScholarPubMed
Mao, W, Yu, XX, Zhong, A, Li, W, Brush, J, Sherwood, SW, Adams, SH & Pan, G (1999) UCP4, a novel brain-specific mitochondrial protein that reduces membrane potential in mammalian cells. FEBS Letters 443, 326–330.CrossRefGoogle ScholarPubMed
Minard, D (1970) Body heat content. In Physiological and Behavioral Temperature Regulation, pp. 345–357. [Hardy, JD, Gagge, AP and Stolwijk, JA, editors]. Springfield, IL: Charles C Thomas.Google Scholar
Nedergaard, J & Cannon, B (1998) Brown adipose tissue: development and function. In Fetal and Neonatal Physiology, pp.478–489 [Polin, R and Fox, W, editors]. Philadelphia, PA WB SaundersGoogle Scholar
Neumann, RA (1902) Experimentelle Beiträge zur Lehre von dem täglichen Nahrungsbedarf des Menschen unter besonderer Berucksichtigung der notwendigen Eiweissmenge (Experimental contributions to the assignment of the daily food requirement of man, with particular consideration of the necessary quantity of eggwhite). Archives des Hygiene und Bakteriologie 45, 1–87.Google Scholar
Newsholme, EA, Crabtree, B & Parry-Billings, M (1992) The energetic cost of regulation: An analysis based on the principles of metabolic-control-logic. In Energy Metabolism: Tissue Determinants and Cellullar Corollaries, pp. 467–493 [Kinney, JM and Tucker, HN, editors]. New York: Raven PressGoogle Scholar
Ohlson, K, Mohell, N, Cannon, B, Lindahl, S & Nedergaard, J (1994) Thermogenesis in brown adipocytes is inhibited by volatile anesthetic agents. Anesthesiology 81, 176–183.CrossRefGoogle ScholarPubMed
Rubner, M (1902) Die Gesetze des Energieverbrauchs bei der Ernährung (The Regulation of Energy Expenditure during Nutrient Intake), [Deuticker, E, editor].Leipzig: Leibzig & Wienna.Google Scholar
SelldéN, E (1998) Amino acid induced thermogenesis during anaesthesia. PhD Thesis, Karolinska Institute, Stockholm, SwedenGoogle Scholar
SelldéN, E, BräNströM, R & Brundin, T (1996) Augmented thermic effect of amino acids under general anaesthesia occurs predominantly in extra-splanchnic tissues. Clinical Science 91, 431–439.CrossRefGoogle ScholarPubMed
SelldéN, E, Brundin, T & Wahren, J (1994) Augmented thermic effect of amino acids under general anaesthesia: a mechanism useful for prevention of anaesthesia-induced hypothermia. Clinical Science 86, 611–618.CrossRefGoogle ScholarPubMed
SelldéN, E & Lindahl, SGE (1998) Postoperative nitrogen excretion after amino acid-induced thermogenesis under anaesthesia. Anesthesia and Analgesia 87, 641–646.CrossRefGoogle Scholar
SelldéN, E & Lindahl, SGE (1999) Amino acid-induced thermogenesis reduces hypothermia during anaesthesia and shortens hospital stay. Anesthesia and Analgesia 89, 916–922.Google ScholarPubMed
SelldéN, E, Rimeika, D, Lindahl, SGE & Settergren, G (2000) Amino acid-induced thermogenesis during cardiac by-pass surgery – no effect on extubation time. Clinical Nutrition 19, 22.Google Scholar
Svanberg, E, MöLler-Loswick, A-C, Matthews, D, KöRner, U, Andersson, M & Lundholm, K (1996) Effects of amino acids on synthesis and degradation of skeletal muscle proteins in humans. American Journal of Physiology 271, E718–E724.Google ScholarPubMed
Theye, RA & Michenfelder, JD (1975) Whole body and organ VO2 changes with enflurane, isoflurane and halothane. British Journal of Anaesthesia 47, 813–817.CrossRefGoogle ScholarPubMed
Thorell, A, Nygren, J & Ljungkvist, O (1999) Insulin resistance: a marker of surgical stress. Current Opinion in Clinical Nutrition and Metabolic Care 2, 69–78.CrossRefGoogle ScholarPubMed
Vaughan, MS, Vaughan, RW & Cork, RC (1981) Postoperative hypothermia in adults; Relationship of age, anaesthesia, and shivering to rewarming. Anesthesia and Analgesia 60, 746–751.Google Scholar
Welle, SL, Lilavivat, U & Campbell, RG (1981) Thermic effect of feeding in man. Increased plasma norepinephrine levels following glucose but not protein or fat consumption. Metabolism 30, 953–958.CrossRefGoogle ScholarPubMed