Amino Acid Infusion in Mothers Before and During Cesarean Delivery

Summary

Introduction: Intravenous infusion of amino acids during cesarean delivery in mothers and neonates improves neonatal growth. Amino acid before and during anesthesia also prevents hypothermia and associated untoward effects. Method: After ethical approval, this prospective randomized double blind controlled study is being conducted in the university hospital of BPKIHS. Seventy six parturients (ASA 1 \& 2) undergoing cesarean delivery without fetal distress, intrauterine growth retardation, congenital malformation or premature labor will be enrolled. For a period starting from approximately one hour prior to spinal anesthesia, Group 1 and Group 2 patients will receive 200 ml of amino acid and lactated ringers solution respectively at 2 ml/kg/hr. The ambient operating room temperature will be maintained near 23º C. No heating methods will be applied apart from covering with a blanket. Primary outcome measure will be neonatal rectal temperature at 0, 5 and 10 min after birth. Secondary outcome measures will be APGAR scores and suckling reflex in the newborn, change in rectal temperature relative to baseline and discomfort related to cold sensation in the mother and the occurrence of shivering both in the mother and newborn.

Timeline

Start

2013-06

Primary completion

2016-04

Completion

2016-04

Publications

• Background Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997 Jun 12;336(24):1730-7. doi: 10.1056/NEJM199706123362407. No abstract available.
• Background Sessler DI, Rubinstein EH, Moayeri A. Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology. 1991 Oct;75(4):594-610. doi: 10.1097/00000542-199110000-00009.
• Background Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997 Apr 9;277(14):1127-34.
• Background Valeri CR, Feingold H, Cassidy G, Ragno G, Khuri S, Altschule MD. Hypothermia-induced reversible platelet dysfunction. Ann Surg. 1987 Feb;205(2):175-81. doi: 10.1097/00000658-198702000-00012.
• Background Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med. 1992 Oct;20(10):1402-5. doi: 10.1097/00003246-199210000-00007.
• Background Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Sessler DI, Narzt E, Lackner F. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997 Dec;87(6):1318-23. doi: 10.1097/00000542-199712000-00009.
• Background Heier T, Caldwell JE, Sessler DI, Miller RD. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. Anesthesiology. 1991 May;74(5):815-9. doi: 10.1097/00000542-199105000-00003.
• Background Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence 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. doi: 10.1056/NEJM199605093341901.
• Background Sellden 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. doi: 10.1042/cs0860611.
• Background Sellden E, Branstrom R, Brundin T. Preoperative infusion of amino acids prevents postoperative hypothermia. Br J Anaesth. 1996 Feb;76(2):227-34. doi: 10.1093/bja/76.2.227.
• Background Sellden E, Lindahl SG. Amino acid-induced thermogenesis reduces hypothermia during anesthesia and shortens hospital stay. Anesth Analg. 1999 Dec;89(6):1551-6. doi: 10.1097/00000539-199912000-00045.
• Background Jequier E. The influence of nutrient administration on energy expenditure in man. Clin Nutr. 1986 Nov;5(4):181-6. doi: 10.1016/0261-5614(86)90022-1.
• Background 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.
• Background Widman J, Hammarqvist F, Sellden E. Amino acid infusion induces thermogenesis and reduces blood loss during hip arthroplasty under spinal anesthesia. Anesth Analg. 2002 Dec;95(6):1757-62, table of contents. doi: 10.1097/00000539-200212000-00053.
• Background Saitoh Y, Kaneda K, Tokunaga Y, Murakawa M. Infusion of amino acid enriched solution hastens recovery from neuromuscular block caused by vecuronium. Br J Anaesth. 2001 Jun;86(6):814-21. doi: 10.1093/bja/86.6.814.
• Background Xing A, Wan B, Zeng W. [Biochemical effects of maternal intravenous and intra-amniotic infusion of amino-acids on fetal blood]. Hua Xi Yi Ke Da Xue Xue Bao. 1994 Mar;25(1):98-102. Chinese.
• Background Ronzoni S, Marconi AM, Cetin I, Paolini CL, Teng C, Pardi G, Battaglia FC. Umbilical amino acid uptake at increasing maternal amino acid concentrations: effect of a maternal amino acid infusate. Am J Obstet Gynecol. 1999 Aug;181(2):477-83. doi: 10.1016/s0002-9378(99)70581-8.
• Background Reynolds RM, Bass KD, Thureen PJ. Achieving positive protein balance in the immediate postoperative period in neonates undergoing abdominal surgery. J Pediatr. 2008 Jan;152(1):63-7. doi: 10.1016/j.jpeds.2007.05.042. Epub 2007 Sep 17.
• Background Wang C, Han LY, Zhang LJ, Wang DH. [Effect of aggressive nutritional support on preterm infants during hospitalization]. Zhonghua Er Ke Za Zhi. 2011 Oct;49(10):771-5. Chinese.
• Background 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. doi: 10.1016/0026-0495(94)90206-2.
• Background 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. doi: 10.1152/ajpendo.1994.266.3.E396.
• Background Regnault TR, de Vrijer B, Battaglia FC. Transport and metabolism of amino acids in placenta. Endocrine. 2002 Oct;19(1):23-41. doi: 10.1385/ENDO:19:1:23.
• Background Fallis WM, Hamelin K, Symonds J, Wang X. Maternal and newborn outcomes related to maternal warming during cesarean delivery. J Obstet Gynecol Neonatal Nurs. 2006 May-Jun;35(3):324-31. doi: 10.1111/j.1552-6909.2006.00052.x.
• Pokharel K, Subedi A, Tripathi M, Biswas BK. Effect of amino acid infusion during cesarean delivery on newborn temperature: a randomized controlled trial. BMC Pregnancy Childbirth. 2021 Mar 31;21(1):267. doi: 10.1186/s12884-021-03734-4.

Drugs

Indications

No indication recorded.