Safety and efficacy of adding intravenous N-acetylcysteine to parenteral L-alanyl-L-glutamine in hospitalized patients undergoing surgery of the colon: a randomized controlled trial

Abstract

BACKGROUND: Colon surgery can cause systemic inflammatory response syndrome (SIRS). There is a recent trend towards the use of antioxidant agents in the prevention or alleviation of the severity of postoperative SIRS, but its use is controversial as studies have shown conflicting results.OBJECTIVES: Investigate the efficacy and tolerability of perioperative intravenous administration of N-acetylcysteine (NAC) as an antioxidant and anti-inflammatory agent in patients undergoing colon surgery.DESIGN: Randomized, double-blinded, and controlled clinical trial.SETTING: Surgical critical care unit in Egypt.PATIENTS AND METHODS: Sixty patients who required admission to the ICU following colon surgery were enrolled in the study between July 2015 and October 2016. Eligibility included the need for parenteral nutrition for at least 5 days due to failure of or contraindication to enteral nutrition. Patients were randomly allocated using a computer-generated list to a loading dose of NAC followed by continuous infusion started one hour prior to induction, and continued over 48 hours, or to the control group, who received the same volume of dextrose 5%. Allocation was concealed using opaque, sealed envelopes under pharmacy control. The researcher, the anesthesiologist, the surgeon, and patients were blinded to the treatment allocation.MAIN OUTCOME MEASURES: Clinical and laboratory evaluation for manifestations of SIRS, serum levels of tumor necrosis factor alpha and malondialdehyde, and occurrence of side effects in the study group.SAMPLE SIZE: 60 patients with mean (SD) ages of 56 (15.1) years in the study group (n=30) and 57.7 (12.3) years in the control group (n=30).RESULTS: There was a significant difference in the mean serum level of ALT (22.6 (9.9) U/L in the study group vs. 31.1 (17.8) U/L in the control group, P=.028) after treatment with NAC, but differences between the groups in the serum level of tumor necrosis factor alpha and malondialdehyde after treatment were not significant. Serum levels of malondialdehyde increased in both groups after treatment P<.001. There was no statistically significant difference from baseline or between the groups after treatment in other clinical data and laboratory parameters following NAC administration, and only 6.6% of the patients in the study group experienced mild side effects.CONCLUSIONS: Preoperative administration of NAC is safe, but its efficacy as an antioxidant and anti-inflammatory agent was not statistically significant and requires further investigation in a larger sample.LIMITATIONS: Single-center study, small sample size, and short duration of NAC administration.CLINICAL TRIALS REGISTRY: NCT03589495.CONFLICT OF INTEREST: None.

Effect of glutamine supplementation on inflammatory markers in critically ill patients supported with enteral or parenteral feeding

“…Glutamine is the most abundant amino acid in plasma and skeletal muscle 1 and acts as a precursor for many amino acids, nucleotides, and other biologicalmolecules. Glutamine is considered as a storage source of glutathione, which is one of the most important antioxidants, and higher levels of glutathione are present in oxidative stress 2,3 …”

N-acetylcysteine and coronavirus disease 2019: May it work as a beneficial preventive and adjuvant therapy? A comprehensive review study

“…As systemic and topical forms, NAC is used in dermatologic applications. [ 26 27 28 35 36 37 38 39 40 41 ] Systematic reviews and meta-analyses in RCTs confirmed the safety, tolerability profile, and effectiveness of NAC in wound healing, photoprotection, pseudoporphyria, xeroderma pigmentosum, onychophagia, systemic sclerosis, Type-I lamellar ichthyosis, toxic epidermal necrolysis, eczema, trichotillomania, acne vulgaris, and bullous morphea. [ 43 ]…”

Clinical efficacy of budesonide combined with acetylcysteine in the treatment of mycoplasma pneumonia infection

“…15 N-acetylcysteine can block the initiation of inflammatory cytokines, exert strong antioxidant function, promote the production of lung surfactant, protect alveolar elasticity, and thus improve lung function. [16][17][18] However, its application in MPP has not been explored.…”

“…The free sulfhydryl group of N‐acetylcysteine can destroy the disulfide bond in the glycoprotein polypeptide chain in sputum, thus cutting down the viscosity of sputum to promote its expulsion 15 . N‐acetylcysteine can block the initiation of inflammatory cytokines, exert strong antioxidant function, promote the production of lung surfactant, protect alveolar elasticity, and thus improve lung function 16–18 . However, its application in MPP has not been explored.…”