Thermoregulatory Response to Aminoacid Infusion during Spinal Anaesthesia
DOI:
https://doi.org/10.14205/2310-9394.2014.02.02.2Keywords:
Anaesthesia, spinal, aminoacid, thermoregulatory.Abstract
Background: Perioperative hypothermia is a common and a major problem in general anaesthesia and neuraxial anaesthesia. Preoperative infusion of amino acids (AA)s is known to prevent perioperative hypothermia during general anaesthesia. We tested the hypothesis that AA infusions given via the intravenous route would also cause thermogenic stimulation under spinal anaesthesia.
Methods: Eighty patients undergoing transurethral tumour resection under spinal anaesthesia were divided into two groups: AA infusion (AA group) starting 1 h before surgery and continued during surgery; saline infusion (control group). The temperature in the tympanic membrane was recorded immediately before infusion commencement and continued throughout anaesthesia. Sensory block level and haemodynamic parameters were recorded during anaesthesia. Postoperative shivering was assessed in postoperative care unit.
Results: Body core (Tcore) values decreased during the study period in comparison with baseline values in the control group. The AA group had significantly higher Tcore values during anaesthesia and surgery compared with the control group. Mean sensory block level and haemodynamic parameters were comparable between the two groups. Shivering occurred significantly more frequently in the control group than in the AA group.
Conclusion: AA infusions can prevent spinal anaesthesia-induced hypothermia without any effects on sensory block level and haemodynamics.
References
Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med. 1992 Oct; 20(10): 1402- 5. http://dx.doi.org/10.1097/00003246-199210000-00007
Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce theincidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996 May 9; 334(19): 1209-15. http://dx.doi.org/10.1056/NEJM199605093341901
Leslie K, Sessler DI. Perioperative hypothermia in the highrisk surgical patient. Best Pract Res Clin Anaesthesiol. 2003 Dec; 17(4): 485-98. Review. http://dx.doi.org/10.1016/S1521-6896(03)00049-1
Sessler DI, Rubinstein EH, Moayeri A. Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology. 1991 Oct; 75(4): 594-610. http://dx.doi.org/10.1097/00000542-199110000-00009
Frank SM, Fleisher LA, Olson KF, Gorman RB, Higgins MS, Breslow MJ, et al. Multivariate determinants of early postoperative oxygen consumption in elderly patients. Effects of shivering, body temperature, and gender. Anesthesiology. 1995 Aug; 83(2): 241-9. http://dx.doi.org/10.1097/00000542-199508000-00002
Putzu M, Casati A, Berti M, Pagliarini G, Fanelli G. Clinical complications, monitoring and management of perioperative mild hypothermia: anesthesiological features. Acta Biomed. 2007 Dec; 78(3): 163-9. Review.
Fujita Y, Tokunaga C, Yamaguchi S, Nakamura K, Horiguchi Y, Kaneko M, et al. Effect of intraoperative amino acids with or without glucose infusion on body temperature, insulin, and blood glucose levels in patients undergoing laparoscopic colectomy: A preliminary report. Acta Anaesthesiol Taiwan. 2014 Jul 29. pii: S1875-4597(14)00077-0. doi: 10.1016/j.aat.2014.04.009.
[Epub ahead of print]
Nakajima Y, Takamata A, Matsukawa T, Sessler DI, Kitamura Y, Ueno H, et al. Effect of amino acid infusion on central thermoregulatory control in humans. Anesthesiology. 2004 Mar; 100(3): 634-9. http://dx.doi.org/10.1097/00000542-200403000-00025
Selldén E, Brundin T, Wahren J. Augmented thermic effect of amino acids under general anaesthesia: a mechanism useful for prevention of anaesthesia-induced hypothermia. Clin Sci (Lond). 1994 May; 86(5): 611-8.
Selldén E, Bränström R, Brundin T. Augmented thermic effect of amino acids under general anaesthesia occurs predominantly in extra-splanchnic tissues. Clin Sci (Lond). 1996 Oct; 91(4): 431-9.
Selldén E, Lindahl SG. Postoperative nitrogen excretion after aminoacid-induced thermogenesis under anesthesia. Anesth Analg. 1998 Sep; 87(3): 641-6.
Yamaoka I, Doi M, Nakayama M, Ozeki A, Mochizuki S, Sugahara K, et al. Intravenous administration of amino acids during anesthesia stimulates muscle protein synthesis and heat accumulation in the body. Am J Physiol Endocrinol Metab. 2006 May; 290(5): E882-8. Epub 2005 Dec 13. http://dx.doi.org/10.1152/ajpendo.00333.2005
Gharavifard M, Sabzevari A, Eslami R. Anesthetic management in a child with citrullinemia: a case report. Anesth Pain Med. 2014 Aug 13; 4(3): e21791. doi:10.5812/aapm.21791. eCollection 2014 Aug. http://dx.doi.org/10.5812/aapm.21791
Crossley AWA, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia 1994; Mar 49 (3): 205-207. http://dx.doi.org/10.1111/j.1365-2044.1994.tb03422.x
Kurz A, Sessler DI, Narzt E, Bekar A, Lenhardt R, Huemer G, et al. Postoperative hemodynamic and thermoregulatory consequences of intraoperativecore hypothermia. J Clin Anesth. 1995 Aug; 7(5): 359-66. http://dx.doi.org/10.1016/0952-8180(95)00028-G
Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology 1995 Mar; 82(3): 662- 73. http://dx.doi.org/10.1097/00000542-199503000-00008
Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow anddistribution during epidural anesthesia. Anesthesiology. 1995 Nov; 83(5): 961-7. http://dx.doi.org/10.1097/00000542-199511000-00008
Ozaki M, Kurz A, Sessler DI, Lenhardt R, Schroeder M, Moayeri A, et al. Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology 1994 Aug; 81(2): 282-8. http://dx.doi.org/10.1097/00000542-199408000-00004
Yamaoka I. Modification of core body temperature by amino acid administration. Asia Pac J Clin Nutr. 2008; 17 Suppl 1:309-11. Review.
Sessler DI. Perioperative thermoregulation and heat balance. Ann N Y Acad Sci. 1997 Mar 15; 813: 757-77. Review. http://dx.doi.org/10.1111/j.1749-6632.1997.tb51779.x
Buhre W, Rossaint R. Perioperative management and monitoring in anaesthesia. Lancet. 2003 Nov 29; 362(9398): 1839-46. Review. http://dx.doi.org/10.1016/S0140-6736(03)14905-7
Brundin T, Wahren J. Influence of protein ingestion on human splanchnic and whole-body oxygen consumption, blood flow, and blood temperature. Metabolism.1994 May; 43(5): 626-32. http://dx.doi.org/10.1016/0026-0495(94)90206-2
Sahin A, Aypar U. Effect of amino acid solutions on intraoperative hypothermia and postoperative shivering. Comparison of two anesthetic regimens. Acta Anaesthesiol Scand. 2002 Jan; 46(1): 64-7.
Brundin T, Wahren J. Influence of a mixed meal on splanchnic and interscapular energy expenditure in humans. Am J Physiol. 1991 Feb; 260(2 Pt 1): E232-7.
Brundin T, Wahren J. Effects of i.v. amino acids on human splanchnic and whole body oxygen consumption, blood flow, and blood temperatures. Am J Physiol. 1994 Mar; 266(3 Pt 1): E396-402.
Selldén E, Bränström R, Brundin T. Preoperative infusion of amino acids prevents postoperative hypothermia. Br J Anaesth. 1996 Feb; 76(2): 227-34. http://dx.doi.org/10.1093/bja/76.2.227
Kasai T, Nakajima Y, Matsukawa T, Ueno H, Sunaguchi M, Mizobe T. Effect of preoperative amino acid infusion on thermoregulatory response during spinal anaesthesia. Br J Anaesth. 2003 Jan; 90(1): 58-61. http://dx.doi.org/10.1093/bja/aeg020
Girod V, Bouvier M, Grélot L. Characterization of lipopolysaccharide-induced emesis in conscious piglets: effects of cervical vagotomy, cyclooxygenase inhibitors and a 5-HT(3) receptor antagonist. Neuropharmacology 2000 Sep; 39(12): 2329-35. http://dx.doi.org/10.1016/S0028-3908(00)00091-5
Widman J, Hammarqvist F, Selldén E. Amino acid infusion induces thermogenesis and reduces blood loss during hip arthroplasty under spinal anesthesia. Anesth Analg. 2002 Dec; 95(6): 1757-62. http://dx.doi.org/10.1097/00000539-200212000-00053
Yatabe T, Yokoyama M.
[Preoperative fluid management contributes to the prevention of intraoperative hypothermia]. Masui. 2011 Jul; 60(7): 824-9. Review.
Ohe Y, Kunimasa K, Watanabe Y. Effects of amino acid infusion in preventing intraoperative hypothermia: comparison between sevoflurane versus propofol. Masui. 2014 Jun; 63(6): 623-8.
Ali NS, El-Hussein KA, Mahmoud JM. Effect of amino acids infusion on thermoregulatory response and blood loss during spinal anesthesia. AJAIC- 2006; 9: 58-65.
Frank SM, Shir Y, Raja SN, Fleisher LA, Beattie C. Core hypothermia and skin-surface temperature gradients. Epidural versus general anesthesia and the effects of age. Anesthesiology 1994 Mar; 80(3): 502-8. http://dx.doi.org/10.1097/00000542-199403000-00005
Frank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology 2000 May; 92(5): 1330-4. http://dx.doi.org/10.1097/00000542-200005000-00022
Colin J, Timbal J, Houdas Y, Boutelier C, Guieu JD. Computation of mean body temperature from rectal and skin temperatures. J Appl Physiol. 1971 Sep; 31(3): 484-9.
Sessler DI. Perioperative heat balance. Anesthesiology. 2000 Feb; 92(2): 578-96. Review. http://dx.doi.org/10.1097/00000542-200002000-00042
Toyota K, Sakura S, Saito Y, Ozasa H, Uchida H. The effect of pre-operative administration of midazolam on the development of intra-operative hypothermia. Anaesthesia. 2004 Feb; 59(2): 116-21. http://dx.doi.org/10.1111/j.1365-2044.2004.03601.x
Frank SM, Beattie C, Christopherson R, Norris EJ, Perler BA, Williams GM, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. The Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology. 1993 Mar; 78(3): 468-76. http://dx.doi.org/10.1097/00000542-199303000-00010
Inoue S, Shinjo T, Kawaguchi M, Nakajima Y, Furuya H. Amino acid infusions started after development of intraoperative core hypothermia do not affect rewarming but reduce the incidence of postoperative shivering during major abdominal surgery: a randomized trial. J Anesth. 2011 Dec; 25(6): 850-4. http://dx.doi.org/10.1007/s00540-011-1230-4