Effects of a single preoperative dose of N(2)-L-alanyl-L-glutamine on insulin resistance and plasma glutathione levels in the early postoperative period

BackgroundAnesthesia and surgery starts a series of stress responses in the body. Subsequently, loss of normal anabolic actions of insulin and development of insulin resistance occur. Resulting hyperglycemia has been considered by an evidence based study as a risk factor for perioperative morbidity and mortality. We tested whether a single preoperative dose of alanyl-glutamine would prevent such responses in addition to maintaining glutathione level; an important factor for maintaining cellular redox potential.MethodsA total of 40 cancer patients were enrolled in this study who received an infusions of 500 ml of Normal Saline started an hour before surgery and continued throughout the surgery. The Dipeptiven® group (20 patients): 2 ml Dipeptiven®/kg were added to saline, while the control group (20 patients): nothing was added to saline. Blood samples were taken a preoperative sample and two postoperative samples (immediately after immergence from anesthesia and 24 h after surgery). These samples were analyzed for plasma glucose, plasma insulin to calculate insulin resistance by HOMA test. Plasma reduced glutathione level was also analyzed in the same time points.ResultsWe found that insulin resistance and glucose level were less in the tested time points in the Dipeptiven® group of patients when compared with the control group. Furthermore, plasma glutathione level was higher in the Dipeptiven® group than the control group.ConclusionPreoperative alanyl-glutamine is helpful in amelioration of insulin resistance and improvement of plasma glutathione levels in the early postoperative period.