Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Anesth Analg. 2012 Oct;115(4):805-13. doi: 10.1213/ANE.0b013e3182632bcb. Epub 2012 Aug 10.
Surgery with general anesthesia disturbs circadian rhythms, which may lead to postoperative sleep disorders and delirium in patients. However, it is unclear how circadian rhythms are affected by different anesthetics administered at different times during the rest-activity cycle. We hypothesized that pentobarbital (an agonist at the γ-aminobutyric acid A receptors) and ketamine (an antagonist at the N-methyl-d-aspartate receptors) would have differential effects on circadian rhythms, and these effects would also be influenced by the time of their administration (the active versus resting phase).
Rats were divided into 4 groups according to the anesthetic administered (pentobarbital or ketamine) and the timing of intraperitoneal administration (active/night phase or resting/day phase). Using online pineal microdialysis, we analyzed pineal melatonin secretion and locomotor activity rhythms in rats under a light/dark (12/12-hour) cycle for 5 days after anesthesia and microdialysis catheter implantation. The data were analyzed for rhythmicity by cosinor analysis.
Ketamine administered during the resting phase produced 65- and 153-minute phase advances, respectively, in melatonin secretion and locomotor activity rhythms on the first day after anesthesia. In contrast, ketamine administered during the active phase produced 43- and 235-minute phase delays. Pentobarbital had no effect on the phase of either melatonin secretion or locomotor activity, irrespective of the timing of administration. When administered during the active phase, both anesthetics decreased the amplitude of melatonin secretion on the day after anesthesia; when administered during the resting phase, however, neither anesthetic affected the amplitude. The amplitude of locomotor activity decreased in all animals for 3 days after anesthesia.
Ketamine has opposite phase-shifting effects on circadian rhythms according to the time of administration, whereas pentobarbital has no effect. Furthermore, both anesthetics decrease the postoperative amplitude of pineal melatonin secretion if administered during the active, but not the resting, phase of the 24-hour rest-activity cycle.
全身麻醉下的手术扰乱了昼夜节律,可能导致术后患者出现睡眠障碍和谵妄。然而,目前尚不清楚在休息-活动周期的不同时间给予不同的麻醉剂如何影响昼夜节律。我们假设戊巴比妥(γ-氨基丁酸 A 受体激动剂)和氯胺酮(N-甲基-D-天冬氨酸受体拮抗剂)对昼夜节律有不同的影响,这些影响还将受到给药时间(活动期/夜间相与休息期/白天相)的影响。
根据给予的麻醉剂(戊巴比妥或氯胺酮)和腹腔内给药的时间(活动/夜间相与休息/白天相),将大鼠分为 4 组。使用在线松果体微透析法,在麻醉和微透析导管植入后的 5 天内,在光/暗(12/12 小时)周期下分析大鼠的松果体褪黑素分泌和运动活动节律。通过余弦分析对数据进行节律性分析。
在麻醉后第一天,休息期给予氯胺酮分别使褪黑素分泌和运动活动节律提前 65 分钟和 153 分钟,而活动期给予氯胺酮则分别使褪黑素分泌和运动活动节律延迟 43 分钟和 235 分钟。戊巴比妥对褪黑素分泌或运动活动的相位均无影响,而与给药时间无关。当在活动期给药时,两种麻醉剂均在麻醉后第一天降低了褪黑素分泌的振幅;然而,当在休息期给药时,两种麻醉剂均不影响褪黑素分泌的振幅。麻醉后所有动物的运动活动振幅在 3 天内均下降。
根据给药时间,氯胺酮对昼夜节律有相反的相位移作用,而戊巴比妥则没有。此外,如果在 24 小时休息-活动周期的活动期而不是休息期给予这两种麻醉剂,都会降低术后松果体褪黑素分泌的振幅。