Kärkelä J, Vakkuri O, Kaukinen S, Huang W-Q, Pasanen M
Department of Anaesthesia and Intensive Care, Tampere University Hospital, Tampere, Finland.
Acta Anaesthesiol Scand. 2002 Jan;46(1):30-6. doi: 10.1034/j.1399-6576.2002.460106.x.
Operations are typically associated with sleep and other circadian rhythm disturbances. The present study was set up to evaluate the influence of spinal and general anaesthesia associated with knee surgery on the circadian rhythm of melatonin, which has sleep inducing properties. Previously this context has been studied only in some invasive operations and it might be that general anaesthesia induces more disturbances on circadian rhythm of melatonin than operations done with patients awake.
The circadian secretion pattern of melatonin was monitored during the pre- and postoperative evenings, nights and mornings to clarify possible anaesthesia/surgery-induced changes in the nocturnal secretion of melatonin and in the phase of the melatonin rhythm. The study included 20 patients scheduled for minor orthopaedic operations. The patients were randomised to receive either spinal or general anaesthesia. Melatonin was measured from evening and morning saliva samples radioimmunologically. The nocturnal urine before and after surgery was radioimmunologically examined for 6-hydroxymelatonin sulphate.
Melatonin secretion evaluated from the saliva samples was significantly diminished during the first postoperative evening as compared with that during the preoperative evening (P<0.001). There was also a significant decline of 26% (P<0.05) in postoperative 6-hydroxymelatonin sulphate excretion. There was no significant difference in melatonin secretion between the spinal and general anaesthesia groups.
Our findings suggest that anaesthesia in conjunction with surgery acutely disturbed the normal circadian rhythm of melatonin by delaying the onset of nocturnal melatonin secretion.
手术通常与睡眠及其他昼夜节律紊乱相关。本研究旨在评估与膝关节手术相关的脊髓麻醉和全身麻醉对褪黑素昼夜节律的影响，褪黑素具有诱导睡眠的特性。此前仅在一些侵入性手术中研究过此情况，可能全身麻醉比患者清醒状态下进行的手术对褪黑素昼夜节律造成的干扰更大。
在术前及术后的傍晚、夜间和早晨监测褪黑素的昼夜分泌模式，以明确麻醉/手术引起的褪黑素夜间分泌及褪黑素节律相位的可能变化。该研究纳入了20例计划进行小型骨科手术的患者。患者被随机分为接受脊髓麻醉或全身麻醉。通过放射免疫法测定傍晚和早晨唾液样本中的褪黑素。对手术前后的夜间尿液进行放射免疫检测，以检测硫酸6-羟基褪黑素。
与术前傍晚相比，术后第一个傍晚唾液样本中评估的褪黑素分泌显著减少（P<0.001）。术后硫酸6-羟基褪黑素排泄也显著下降了26%（P<0.05）。脊髓麻醉组和全身麻醉组之间的褪黑素分泌无显著差异。
我们的研究结果表明，麻醉联合手术通过延迟夜间褪黑素分泌的开始，急性扰乱了褪黑素的正常昼夜节律。
