Intravenous alanyl-L-glutamine balances glucoseinsulin homeostasis and facilitates recovery in patients undergoing colonic resection: A randomised controlled trial

Cui, Yan*; Hu, Liu; Liu, Yue-jiang; Wu, Ya-mou; Jing, Liang*

European Journal of Anaesthesiology: April 2014 - Volume 31 - Issue 4 - p 212–218
doi: 10.1097/EJA.0b013e328360c6b9

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−1 of physiological saline, a 8.5% 18AA-II solution (a compound amino acid) or glutamine 0.5 g kg−1, 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.

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.

Correspondence to Dr Liang Jing, Department of Anesthesiology, Zhongda Hospital and College of Medicine, Southeast University, No. 87, Ding Jia Qiao Rd., Nanjing 210009, Jiangsu, China Tel: +86 25 8327 2056; e-mail:

Published online 28 April 2013

© 2014 European Society of Anaesthesiology