ASPECTS OF PROTEIN-METABOLISM AFTER ELECTIVE SURGERY IN PATIENTS RECEIVING CONSTANT NUTRITIONAL SUPPORT

The present study was designed in an attempt to resolve conflicting views currently in the literature relating to the effect of surgery on various aspects of protein metabolism. Sequential post-operative (2, 4 and 6 days) changes in whole-body protein turnover, forearm arteriovenous difference of plasma amino acids, glucose,lactate and free fatty acids, muscle concentration of free amino acids, RNA and protein, urinary nitrogen and 3-methylhistidine, plasma concentrations of insulin, cortisol and growth hormone, and resting metabolic rate, were measured in six patients undergoing uncomplicated elective total abdominal hysterectomy. All patients received a constant daily diet, either orally or intravenously, based on 0.1 g of nitrogen/kg and an energy content of 1.1 times the resting metabolic rate for 7 days before and 6 days after surgery. Whole-body protein turnover, synthesis and breakdown increased significantly 2 days after surgery (P < 0.05) and returned towards pre-operative levels thereafter. Forearm release of branched-chain amino acids and alanine, and mefflux of glucose and lactate, were enhanced 4 days after surgery (P < 0.05). Muscle glutamine and alanine concentrations were decreased on the fourth and sixth days after surgery (P < 0.05). The RNA/protein ratio (indicating the capacity for protein synthesis) was unaltered. A significant increase in urinary nitrogen and 3-methylhistidine was observed on days 3 and 4 after surgery (P < 0.05). Thereafter, these parameters remained elevated, although failing to reach statistical significance. The resting metabolic rate was significantly increased (P < 0.05) 2 days after surgery but the respiratory quotient (0.77) was unchanged. These data support the contention that whole-body protein synthesis and breakdown increase after surgery. Differences observed pre- and post-operatively between leucine kinetic estimates and other methods of quantifying protein metabolism indicate that only like methodologies should be compared.