Aspects of protein metabolism after elective surgery in patients receiving constant nutritional support

Carli, Francesco; Webster, J. Matthew; Ramachandra, Vino; Pearson, M.; Read, M.; Ford, G. C.; McArthur, Silvia Gatti; Preedy, V. R.; Halliday, D.

doi:10.1042/cs0780621

Cited by 50 publications

(27 citation statements)

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“…Urinary nitrogen losses in both groups did not exceed those found in normal healthy volunteers during several days of hypocaloric parenteral nutrition (approximately 11 g nitrogen per day) 23 . This is in contrast to the accelerated nitrogen losses seen during the first few days after major abdominal surgery in traditional practice (approximately 12-16 g nitrogen per day) 24,25 . Furthermore, nitrogen balance was achieved in patients given complete enteral feed, which is also in contrast to the negative nitrogen balance reported during 1-4 days after major abdominal surgery in traditional care with enteral 26 or even parenteral 27 nutrition.…”

Section: Discussionmentioning

confidence: 89%

Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol

Soop

Carlson

Hopkinson

et al. 2004

British Journal of Surgery

147

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Section: Discussionmentioning

confidence: 89%

Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol

Soop

Carlson

Hopkinson

et al. 2004

British Journal of Surgery

147

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“…6 When comparing intravenous with volatile GA, it has been reported that propofol combined with remifentanil inhibits the ACTHecortisol axis and catecholamine and growth hormone increase compared to volatile GA. 7 Metabolic changes secondary to surgical stress include an increase in proteolysis after surgery, leading to muscle breakdown and loss. 8 The use of a combined spinal and epidural blockade during hip surgery has been shown to attenuate the increase in amino acid oxidation 24 hours after surgery, in comparison to GA. 9 Among GA reagents, the use of propofol has been found to cause a reduction in the proteolytic response to surgery, by potentially allowing the body to make use of triglycerides contained within the propofol emulsion as a substitute. 10 The increase in glucose production during surgery can also be prevented by epidural analgesia, yet inhaled anesthetics appear to have no effect.…”

Section: Surgical Stress Responsementioning

confidence: 99%

Anesthesia, surgical stress, and “long-term” outcomes

Iwasaki

Edmondson

Sakamoto

et al. 2015

Acta Anaesthesiologica Taiwanica

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An increasing body of evidence shows that the choice of anesthetic can strongly influence more than simply the quality of anesthesia. Regional and general anesthesia have often been compared to ascertain whether one provides benefits through dampening the stress response or harms by accelerating cancer progression. Regional anesthesia offers considerable advantages, by suppressing cortisol and catecholamine levels and reducing muscle breakdown postoperatively. It also has less immunosuppressive effect and potentially reduces the proinflammatory cytokine response. As such, vital organ functions (e.g., brain and kidney) may be better preserved with regional anesthetics, however, further study is needed. Volatile general anesthetics appear to promote cancer malignancy in comparison to regional and intravenous general anesthetics, and reduce the body's ability to act against cancer cells by suppression of natural killer cell activity. There is not sufficient evidence to support an alteration of current clinical practice, however, further research into this area is warranted due to the potential implications elicited by current studies.

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“…The mechanisms by which nutrition modulates protein metabolism are still not completely defined, but the assumption underlying clinical practice and metabolic research is that injury provokes a metabolic response characterized by unavoidable net protein breakdown that can be reduced with proper nutritional support (Carli et al, 1990;Jeevanandam et al, 1991;Romito, 1995;Waterlow, 1995;Hasselgren and Tiao, 1996).…”

Section: Introductionmentioning

confidence: 99%

Nutritional modulation of protein metabolism after gastrointestinal surgery

et al. 2007

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Background: The metabolic response to surgery includes alterations in protein metabolism, resulting in a net loss of proteins. Protein hypercatabolism is considered an unavoidable consequence of injury, and an important source of morbidity and mortality. Our purpose was to determine the effect of nutrition on protein metabolism following gastrointestinal surgery, and to elucidate whether postoperative protein loss can be prevented with adequate nutritional support. Methods: Patients who had undergone gastrointestinal surgery were given four different parenteral nutritions with increasing glucose, lipid and amino acid content during the 7 days following surgery. Nitrogen balance, protein synthesis and protein breakdown were determined using in vivo stable isotope labelling. Other metabolites (3-methylhistidine, creatinine, urea, cortisol, glucose, insulin, amino acids and C-reactive protein) were measured. Results: A nutrition-dependent alteration of protein metabolism was found in response to surgical injury. Nutrition modified nitrogen balance, whole-body protein breakdown and, to a lesser extent, whole-body protein synthesis and muscle protein breakdown. The low-energy parenteral nutrition without amino acids produced a negative nitrogen balance (postoperative day 7 ¼ À0.381 g protein kg À1 day À1 ) and important alterations in postoperative protein metabolism that did not normalize during the study period (day 7 protein synthesis ¼ 239% and protein breakdown 217% vs preoperative). Patients receiving the two low energy parenteral nutritions containing amino acids had a less negative nitrogen balance (day 7 ¼ À0.011 and À0.133 g protein kg À1 day À1 ) and a transient increase in protein metabolism. The complete parenteral nutrition maintained, during all studied days, protein metabolism parameters within the preoperative reference range (synthesis day 2 ¼ 92%, day 4 ¼ 110% day 7 ¼ 79%; breakdown day 2 ¼ 85%, day 4 ¼ 80%, day 7 ¼ 76% vs preoperative) and a positive nitrogen balance (day 2 ¼ þ 0.0387, day 4 ¼ þ 0.578 and day 7 ¼ þ 0.227 g protein kg À1 day À1 ). Conclusion: Complete nutritional support can prevent protein loss after gastrointestinal surgery and maintain protein metabolism without alterations.

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Aspects of protein metabolism after elective surgery in patients receiving constant nutritional support

Cited by 50 publications

References 0 publications

Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol

Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol

Anesthesia, surgical stress, and “long-term” outcomes

Nutritional modulation of protein metabolism after gastrointestinal surgery

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