Effect of General Anaesthesia on Whole Body Protein Turnover in Patients Undergoing Elective Surgery

Carli, F.; Ramachandra, Vino; Gandy, Joan; Merritt, H. Houston; Ford, G. C.; Read, M.; Halliday, D.

doi:10.1093/bja/65.3.373

Cited by 26 publications

(12 citation statements)

References 16 publications

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“…31 Although the exact location of the observed surgery induced upregulation of whole body protein turnover remains unclear, it is likely that the increased protein breakdown is taking place in the splanchnic as well as in the muscle compartment. A previous study in unpremedicated females undergoing elective total abdominal hysterectomy 25 showed that whole body protein breakdown did not change with general anaesthesia but decreased with both surgery and anaesthesia, and during the acute recovery period. It remains unclear whether the combination of multiple factors (including medication, starvation, anaesthesia, trauma , after intake of the high protein supplement.…”

Section: Metabolic Effects Of Breast Surgerymentioning

confidence: 82%

“…muscle) are mobilized . Previously, decreased, increased, and unchanged protein breakdown rates were observed after surgery, likely due to variations in the extent of trauma, postoperative phase (early or late), and methods used to quantify protein breakdown. A previous study found increased albumin synthesis levels after major abdominal surgery .…”

Section: Discussionmentioning

confidence: 99%

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Presence of early stage cancer does not impair the early protein metabolic response to major surgery

Engelen

Klimberg

Allasia

et al. 2017

J cachexia sarcopenia muscle

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BackgroundCombined bilateral mastectomy and reconstruction is a common major surgical procedure in women with breast cancer and in those with a family history of breast cancer. As this large surgical procedure induces muscle protein loss, a preserved anabolic response to nutrition is warranted for optimal recovery. It is unclear whether the presence of early stage cancer negatively affects the protein metabolic response to major surgery as this would mandate perioperative nutritional support.MethodsIn nine women with early stage (Stage II) breast malignancy and nine healthy women with a genetic predisposition to breast cancer undergoing the same large surgical procedure, we examined whether surgery influences the catabolic response to overnight fasting and the anabolic response to nutrition differently. Prior to and within 24 h after combined bilateral mastectomy and reconstruction surgery, whole body protein synthesis and breakdown rates were assessed after overnight fasting and after meal intake by stable isotope methodology to enable the calculation of net protein catabolism in the post‐absorptive state and net protein anabolic response to a meal.ResultsMajor surgery resulted in an up‐regulation of post‐absorptive protein synthesis and breakdown rates (P < 0.001) and lower net protein catabolism (P < 0.05) and was associated with insulin resistance and increased systemic inflammation (P < 0.01). Net anabolic response to the meal was reduced after surgery (P < 0.05) but higher in cancer (P < 0.05) indicative of a more preserved meal efficiency. The significant relationship between net protein anabolism and the amount of amino acids available in the circulation (R 2 = 0.85, P < 0.001) was independent of the presence of non‐cachectic early stage breast cancer or surgery.ConclusionsThe presence of early stage breast cancer does not enhance the normal catabolic response to major surgery or further attenuates the anabolic response to meal intake within 24 h after major surgery in patients with non‐cachectic breast cancer. This indicates that the acute anabolic potential to conventional feeding is maintained in non‐cachectic early stage breast cancer after major surgery.

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Section: Metabolic Effects Of Breast Surgerymentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Presence of early stage cancer does not impair the early protein metabolic response to major surgery

Engelen

Klimberg

Allasia

et al. 2017

J cachexia sarcopenia muscle

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“…Clonidine has been shown to blunt this effect as well, likely through an increase in norepinephrine, activating descending spinal pathways and directly blocking ACTH secretion 9 . General anesthetics, without opioids or benzodiazepines, have not been found to be effective at blunting the surgical stress response 10,11 . These findings have led to the routine use of opioids with general anesthesia and the frequent use of local and epidural anesthesia.…”

Section: The Surgical Stress Responsementioning

confidence: 99%

The Surgical Stress Response, Preemptive Analgesia, and Procedural Sedation in the Emergency Department

Miner

2008

Academic Emergency Medicine

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“…Lattermann et al (23) detected catabolism by a decline in protein synthesis and an increase in amino acid oxidation within the first two hours following surgery, in patients who underwent colectomy. In another study, Carli et al (24) pointed to decreased protein catabolism intraoperatively and in the first 2 hours postoperatively. Increase in urinary nitrogen levels and negative nitrogen balance can be detected at an early stage after injury peaking at day 7.…”

Section: Protein and Amino Acid Metabolismmentioning

confidence: 94%

Response to trauma and metabolic changes: posttraumatic metabolism

Şimşek

Cantürk

2014

UCD

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Response to trauma and metabolic changes: posttraumatic metabolism Stress response caused by events such as surgical trauma includes endocrine, metabolic and immunological changes. Stress hormones and cytokines play a role in these reactions. More reactions are induced by greater stress, ultimately leading to greater catabolic effects. Cuthbertson reported the characteristic response that occurs in trauma patients: protein and fat consumption and protection of body fluids and electrolytes because of hypermetabolism in the early period. The oxygen and energy requirement increases in proportion to the severity of trauma. The awareness of alterations in amino acid, lipid, and carbohydrate metabolism changes in surgical patients is important in determining metabolic and nutritional support. The main metabolic change in response to injury that leads to a series of reactions is the reduction of the normal anabolic effect of insulin, i.e. the development of insulin resistance. Free fatty acids are primary sources of energy after trauma. Triglycerides meet 50 to 80 % of the consumed energy after trauma and in critical illness. Surgical stress and trauma result in a reduction in protein synthesis and moderate protein degradation. Severe trauma, burns and sepsis result in increased protein degradation. The aim of glucose administration to surgical patients during fasting is to reduce proteolysis and to prevent loss of muscle mass. In major stress such as sepsis and trauma, it is important both to reduce the catabolic response that is the key to faster healing after surgery and to obtain a balanced metabolism in the shortest possible time with minimum loss. For these reasons, the details of metabolic response to trauma should be known in managing these situations and patients should be treated accordingly.Key Words: Posttraumatic metabolism, stress response, trauma response INTRODUCTIONResponse to trauma includes various endocrine, metabolic and immunological changes. The severity of these changes is related to the amount of exposed stress. In the activation of central nervous system and hormonal responses against injury, the direct effect of mediators like TNF-α and IL 1, which are released from traumatic tissue, on the hypothalamus has been well-known. However, many new studies refer to nuclear factor kappa B (NF-kB) in this regard. In a burn-rat model study, it was stated that melatonin, which is protective against liver damage, played a role in the suppression of NF-kB that is accepted as a mediator of inflammatory response, and melatonin treatment reduced the significantly increased hepatic NF-kB and TNF-α activity (1).Protein malnutrition affects defense against infection by disrupting inflammatory response. Glutamine, although considered as a non-essential amino acid, has been shown to be essential in cases such as trauma, surgery, or sepsis where cytokine synthesis is modulated. In a study, it was noted that the effect of glutamine on macrophage activation and TNF-α synthesis is dose-dependent, and it effects the N...

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Effect of General Anaesthesia on Whole Body Protein Turnover in Patients Undergoing Elective Surgery

Cited by 26 publications

References 16 publications

Presence of early stage cancer does not impair the early protein metabolic response to major surgery

Presence of early stage cancer does not impair the early protein metabolic response to major surgery

The Surgical Stress Response, Preemptive Analgesia, and Procedural Sedation in the Emergency Department

Response to trauma and metabolic changes: posttraumatic metabolism

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