Amino Acids during Perioperative Period

Abstract

During anesthesia, thermoregulation is impaired and hypothermia will frequently occur in most patients. Hypothermia affects immunologic activity, bleeding tendency and the recovery from anesthesia. Therefore, it may prolong hospital stay, and increase morbidity, e.g. surgical site infections, cardiac events and multiple organ dysfunctions in trauma. External warming is often used to prevent hypothermia. However, infusion of amino acids is also valuable to prevent hypothermia due to their enhanced thermogenic action under anesthesia. During surgery, amino acids administration would maintain the body homeostasis, and counteract the disadvantageous fasting metabolism. Postoperatively, amino acids may be advantageous for the healing of the surgical wound. Thus, appropriate nutritional management, including glucose, during the perioperative period would prevent catabolism, frequently occurring after surgery. Protocols like ERAS (Enhanced Recovery After Surgery) are proposed for quick recovery after surgery. ERAS protocol recommends preoperative carbohydrate and early enteral nutrition, but does not include infusion of amino acids during the perioperative period. During prolonged surgery, patients clearly need good nutritional support. In this article, we intend to describe the problems of hypothermia briefly, and explain the mechanism of amino acids in hypothermia prevention. In addition, we address some evidences of nutritional management during the perioperative period.

Effect of amino acid infusion on perioperative thermoregulation in newborn surgery

“…All reactions require larger amounts of energy compared with glucose or lipid metabolism, leading to accumulating heat in the body [11]. After Sellden et al reported that amino acid infusion prevented perioperative hypothermia during anesthesia without any additional sympathoadrenal activity and shortened hospital stay [6,15,16], Kasai et al [8] reported perioperative amino acids maintained core temperature and were useful in preventing hypothermia not only during general anesthesia but also during spinal anesthesia.…”

“…Patients can be intensively warmed or simply kept warm either by elevating the ambient temperature or by the use of extracorporeal devices such as forced-air warming blowers and infusion fluid warming devices during general anesthesia [3,5]. As a different approach, perioperative amino acid infusion is known to prevent intraoperative hypothermia during general anesthesia in adults [6][7][8][9][10][11].…”

Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery

“…Can the supplementation with essential amino acids in early refeeding/first days after intervention enhance recovery and reduce complications? This type of supplementation has shown efficacy in many types of surgery, counteracting malnutrition and promoting healing [96][97][98][99][100][101][102][103][104][105].…”

Effects of intraoperative hypothermia on stress hormon response in surgical patients

“…Amino acids infusion might be intraoperatively beneficial for surgical patients because it can counteract the disadvantageous fasting metabolism; metabolic fate is two-fold: oxidation for energy production and/or building blocks fore protein synthesis. In both cases large amounts of energy are needed for amino acid metabolism and eventually heat production (10). In recent systematic review and meta-analysis regarding perioperative amino acid infusion for preventing hypothermia, it was demonstrated that, based on 626 participants from 14 randomized controlled trials, amino acid infusion led to a +0.46 °C increase in temperature.…”