Journal of Anesthesia

, Volume 27, Issue 3, pp 359–365 | Cite as

Protein sparing during general anesthesia with a propofol solution containing medium-chain triglycerides for gastrectomy: comparison with sevoflurane anesthesia

  • Yoshiaki Nagao
  • Tsuneo Tatara
  • Kimihiko Fujita
  • Takashi Sugi
  • Joji Kotani
  • Munetaka Hirose
Original Article

Abstract

Purpose

Despite the importance of the inhibition of catabolic response to surgery, the effects of different anesthetic techniques on the catabolic response in surgical patients are controversial. This study compared the endocrine-metabolic responses and protein catabolism during gastrectomy in patients who received either sevoflurane or propofol anesthesia with remifentanil.

Methods

Thirty-seven patients (American Society of Anesthesiologists status I–III) aged 20–79 years undergoing elective gastrectomy were randomly assigned to receive sevoflurane anesthesia with remifentanil (n = 19) or intravenous propofol anesthesia (Propofol-Lipuro® 1 %; B. Braun, Melshungen AG, Germany) with remifentanil (n = 18). Urine samples were collected every 1 h after skin incision (0 h) and the urinary 3-methylhistidine:creatinine ratio (3-MH/Cr ratio) was used as a marker of protein catabolism. Respiratory quotient was measured during a 1 h period following skin incision.

Results

The 3-MH/Cr ratio significantly increased at 1–2 and 2–3 h compared to 0 and 0–1 h in both groups, but the propofol group exhibited a lower 3-MH/Cr ratio (nmol/μmol) than the sevoflurane group at 1–2 h (15.7 vs. 18.2, P = 0.012) and 2–3 h (15.9 vs. 18.1, P = 0.025). A difference was observed in the respiratory quotient between the sevoflurane and propofol groups (0.726 vs. 0.707, P = 0.003).

Conclusion

A lower 3-MH/Cr ratio and a lower respiratory quotient during propofol anesthesia, compared to those exhibited during sevoflurane anesthesia, suggest that protein sparing probably occurs through the utilization of medium-chain triglycerides contained in the fat emulsion of propofol solution as a fuel source.

Keywords

Fat emulsion Free fatty acid 3-Methylhistidine Protein metabolism 

Notes

Acknowledgments

We thank Ms. Saya Sonoda for technical assistance with measurements of urinary metabolites, and Dr. Kazuhiko Fukatsu and Dr. Atsunori Nakao for critical comments and valuable suggestions. This study was supported by Grants-in-Aid for Researchers, Hyogo College of Medicine, 2009.

Conflict of interest

The authors have no conflicts of interest.

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Copyright information

© Japanese Society of Anesthesiologists 2012

Authors and Affiliations

  • Yoshiaki Nagao
    • 1
  • Tsuneo Tatara
    • 1
  • Kimihiko Fujita
    • 1
  • Takashi Sugi
    • 1
  • Joji Kotani
    • 2
  • Munetaka Hirose
    • 1
  1. 1.Department of AnesthesiologyHyogo College of MedicineNishinomiyaJapan
  2. 2.Department of Emergency and Critical Care MedicineHyogo College of MedicineHyogoJapan

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