Health  Vol.6 No.10 , April 2014
Increased Nitrogen Retention after Trans-Operative Intravenous Amino Acid and Glucose Infusion, without Changes in Urinary Amino Acid, Adrenaline and Plasma Urea or Glucose
Abstract: Objective: Nutritional deficiencies are associated with increased morbidity and mortality during and after surgery. The present study evaluated nitrogen retention after transoperative intravenous infusion of amino acids and glucose. Design: Prospective study. Setting: Large community hospital. Patients: 18 randomly chosen patients undergoing medium or major surgeries. Interventions and Measurements: The experimental design included a 12-hour period before surgery (P1), a trans-operative period of 6 hours (P2), an early postoperative period (P3, 18 hours), and a late postoperative period (P4, 24 hours). Urinary amino acid and nitrogen were analyzed from P1 through P4. Group I, nine patients, received Ringer’s lactate solution with 5% glucose, and Group II, another nine patients, received a 6.6% amino acid and 16.6% glucose solution over a 6-hour trans-operative period (P2) starting from the anesthesia procedures. All surgical procedures lasted a maximum of 3 hours. Results: There was no statistically significant difference in urinary amino acid or adrenaline excretion between P1 and P4 in either group. Nitrogen excretion values were also similar for both groups, i.e., 0.39 ± 0.16 and 0.39 ± 0.28 g/hour, respectively. The nitrogen balance showed greater nitrogen retention (﹣0.25 ± 0.24 g/hour) in the group receiving the amino acid infusion compared to the group receiving Ringer’s lactate solution (﹣0.59 ± 0.26 g/hour) (P < 0.05). Blood plasma urea nitrogen and glycaemia did not increase at the end of the study (P4 period) in either group. Conclusion: These data indicate that trans-operative infusion of glucose and amino acids can be beneficial for patients submitted to surgical stress in terms of nitrogen retention.
Cite this paper: Albuquerque-Filho, E. , Juca, M. , Padovan, G. and Marchini, J. (2014) Increased Nitrogen Retention after Trans-Operative Intravenous Amino Acid and Glucose Infusion, without Changes in Urinary Amino Acid, Adrenaline and Plasma Urea or Glucose. Health, 6, 1012-1018. doi: 10.4236/health.2014.610127.

[1]   Sun, X., Oberlander, D., Huang, J. and Weissman, C. (1998) Fluid Resuscitation, Nutritional Support, and Cholesterol in Critically Ill Postsurgical Patients. Journal of Clinical Anesthesia, 10, 302-308.

[2]   Cammu, G., Vermeiren, K., Lecomte, P., Gendt, S.D., Deloof, T. and Foubert, L. (2009) Perioperative Blood Glucose Management in Patients Undergoing Tumor Hepatectomy. Journal of Clinical Anesthesia, 21, 329-335.

[3]   Tannus, A.F.S., Carvalho, R.L.V., Suen, V.M.M., Cardoso, J.B., Okano, N. and Marchini, J.S. (2001) Energy Expenditure after 2- to 3-Hour Elective Surgical Operations. Revista do Hospital das Clínicas, 56, 37-40.

[4]   Collins, J.P., Oxby, C.B. and Hill, G.L. (1978) Intravenous Amino Acids and Intravenous Hyperalimentation as Protein-Sparing Therapy after Major Surgery. A Controlled Clinical Trial. Lancet, 8068, 788-791.

[5]   Soop, M., Nygren, J., Thorell, A., Weidenhielm, L., Lundberg, M., Hammarqvist, F., et al. (2004) Preoperative Oral Carbohydrate Treatment Attenuates Endogenous Glucose Release 3 Days after Surgery. Clinical Nutrition, 23, 733-741.

[6]   Chambrier, C., Aouifi, A., Bon, C., Saudin, F., Paturel, B. and Bouletreau, P. (1999) Effects of Intraoperative Glucose Administration on Circulating Metabolites and Nitrogen Balance during Prolonged Surgery. Journal of Clinical Anesthesia, 11, 646-651.

[7]   Helminen, H., Raitanen, M. and Kellosalo, J. (2007) Immunonutrition in Elective Gastrointestinal Surgery Patients. Scandinavian Journal of Surgery, 96, 46-50.

[8]   Wolters, U., Wolf, T., Stützer, H. and Schroder, T. (1996) ASA Classification and Perioperative Variables as Predictors of Postoperative Outcome. British Journal of Anaesthesia, 77, 217-222.

[9]   Kjeldahl, J. (1883) Neue methods zurbestimmung des stickstoffs in organischenkorpern. Zeitschrift für Analytische Chemie, 22, 366-382.

[10]   Carducci, C., Birarelli, M., Leuzzi, V., Santagata, G., Serafini, P. and Antonozzi, I. (1996) Automated Method for the Measurement of Amino Acids in Urine by High-Performance Liquid Chromatography. Journal of Chromatography A, 729, 173-180.

[11]   Jeon, H.K., Nohta, H. and Ohkura, Y. (1992) High-Performance Liquid Chromatographic Determination of Catecholamines and Their Precursor and Metabolites in Human Urine and Plasma by Postcolumn Derivatization Involving Chemical Oxidation Followed by Fluorescence Reaction. Analytical Biochemistry, 200, 332-338.

[12]   Kruimel, J.W., Naber, T.H., van der Vliet, J.A., Carneheim, C., Katan, M.B. and Jansen, J.B. (2001) Parenteral Structured Triglyceride Emulsion Improves Nitrogen Balance and Is Cleared Faster from the Blood in Moderately Catabolic Patients. Journal of Parenteral and Enteral Nutrition, 25, 237-244.

[13]   Lugli, A.K., Donatelli, F., Schricker, T., Wykes, L. and Carli, F. (2008) Epidural Analgesia Enhances the Postoperative Anabolic Effect of Amino Acids in Diabetes Mellitus Type 2 Patients Undergoing Colon Surgery. Anesthesiology, 108, 1093-1099.

[14]   Chan, R.P.C., Galas, F.R.B.G., Hajjar, L.A., Bello, C.N., Piccioni, M.A. and Auler, J.O.C. (2009) Intensive Perioperative Glucose Control Does Not Improve Outcomes of Patients Submitted to Open-Heart Surgery: A Randomized Controlled Trial. Clinics, 64, 51-60.

[15]   Marchini, J.S., Moreira, E.A.M., Moreira, M.Z., Hiramatsu, T., Oliveira, J.E.D. and Vannucchi, H. (1996) Whole Body Protein Metabolism Turnover in Men on a High or Low Calorie Rice and Bean Brazilian Diet. Nutrition Research, 16, 435-441.

[16]   Rittler, P., Kuppinger, D., Krick, M., Demmelmair, H., Koletzko, B., Jauch, K.W. and Hartl, W.H. (2009) Differential Regulation of Protein Synthesis in Hepatic and Intestinal Tissues by Amino Acids: Studies in Patients Recovering from Major Abdominal Operations. Surgery, 146, 113-121.

[17]   Svanfeldt, M., Thorell, A., Nygren, J. and Ljungqvist, O. (2006) Postoperative Parenteral Nutrition While Proactively Minimizing Insulin Resistance. Nutrition, 22, 457-464.

[18]   López-Hellin, J., Baena-Fustegueras, J.A., Vidal, M., Riera, S.S. and García-Arumí, E. (2004) Perioperative Nutrition Prevents the Early Protein Losses in Patients Submitted to Gastrointestinal Surgery. Clinical Nutrition, 23, 1001-1008.

[19]   Berard, M.P., Pelletier, A., Ollivier, J.M., Gentil, B. and Cynober, L. (2002) Qualitative Manipulation of Amino Acid Supply during Total Parenteral Nutrition in Surgical Patients. Journal of Parenteral and Enteral Nutrition, 26, 136-143.

[20]   Wang, X.Y., Li, N., Gu, J., Li, W.Q. and Li, J.S. (2003) The Effects of the Formula of Amino Acids Enriched BCAA on Nutritional Support in Traumatic Patients. World Journal of Gastroenterology, 9, 599-602.

[21]   Heslin, M.J. and Brennan, M.F. (2000) Advances in Perioperative Nutrition: Cancer. World Journal of Surgery, 24, 1477-1485.

[22]   Sellden, E. and Lindahl, S.G.E. (1998) Postoperative Nitrogen Excretion after Amino Acid-Induced Thermogenesis under Anesthesia. Anesthesia & Analgesia, 87, 641-646.

[23]   Moriyama, T., Tsuneyoshi, I., Omae, T., Takeyama, M. and Kanmura, Y. (2008) The Effect of Amino-Acid Infusion during Off-Pump Coronary Arterial Bypass Surgery on Thermogenic and Hormonal Regulation. Journal of Anesthesia, 22, 354-360.