Intravenous alanyl-L-glutamine balances glucose-insulin homeostasis and facilitates recovery in patients undergoing colonic resection: a randomised controlled trial

  • Eur J Anaesthesiol. 2014 Apr;31(4):212-8. doi: 10.1097/EJA.0b013e328360c6b9.
Yan Cui  1 ,  Liu Hu ,  Yue-jiang Liu ,  Ya-mou Wu ,  Liang Jing
Affiliations
  • 1. From the Department of Anesthesiology, Zhongda Hospital and College of Medicine, Southeast University, Jiangsu, China *Yan Cui and Liang Jing contributed equally to this work.
PMID: 24374803 DOI: 10.1097/EJA.0b013e328360c6b9
Abstract

Background: Glucose and Insulin homeostasis are altered in patients undergoing gastro-intestinal tumour resection and affect the postsurgical outcomes.

Objectives: To evaluate the impact of dipeptide alanyl-L-glutamine supplementation on glucose-insulin homeostasis, inflammatory mediators and surgical recovery in patients undergoing colonic Cancer resection.

Design: A randomised controlled trial.

Setting: Southeast University Affiliated Zhongda Hospital, China, from January 2011 to May 2011.

Participants: Patients aged 35 to 75 years, ASA physical status I-II, scheduled for elective colon Cancer resection.

Interventions: Sixty patients were randomised into one of the three groups and received 22.4 ml kg of physiological saline, a 8.5% 18AA-II solution (a compound amino acid) or glutamine 0.5 g kg, given 24 h before and 1 h after the start of the surgical procedure.

Primary outcomes measure: Insulin Resistance index and Insulin sensitivity check index. Secondary outcomes included blood glucose, Insulin, tumour necrosis factor-alpha (TNF-α) and free fatty acid measured at 24 h before surgery (T1), 30 min before anaesthesia (T2), 2.5 h after the beginning of surgery (T3), and 1 h (T4) and 24 h (T5) after the end of surgery. The time of first passage of wind and the length of hospital stay were recorded.

Results: Intraoperative and postoperative Insulin Resistance or calculated Insulin sensitivity were worse in the physiological saline and 18AA-II treated patients compared with those treated with glutamine (P < 0.05). Blood glucose increased intraoperatively and postoperatively in all three groups compared with baselines (P < 0.05), but glutamine attentuated the PEAK level of blood glucose (P < 0.05). Glutamine reduced the intraoperative and postoperative concentrations of TNF-α and free fatty acid, (P < 0.05), and shortened the time to the first passage of wind after surgery and the length of hospital stay (P < 0.05).

Conclusion: Intravenous supplementation with glutamine balances glucose-insulin homeostasis and facilitates recovery in patients undergoing colon Cancer resection.

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