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Touitou Y, Cermakian N, Touitou C. The environment and the internal clocks: The study of their relationships from prehistoric to modern times. Chronobiol Int 2024; 41:859-887. [PMID: 38757600 DOI: 10.1080/07420528.2024.2353857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
The origin of biological rhythms goes back to the very beginning of life. They are observed in the animal and plant world at all levels of organization, from cells to ecosystems. As early as the 18th century, plant scientists were the first to explain the relationship between flowering cycles and environmental cycles, emphasizing the importance of daily light-dark cycles and the seasons. Our temporal structure is controlled by external and internal rhythmic signals. Light is the main synchronizer of the circadian system, as daily exposure to light entrains our clock over 24 hours, the endogenous period of the circadian system being close to, but not exactly, 24 hours. In 1960, a seminal scientific meeting, the Cold Spring Harbor Symposium on Biological Rhythms, brought together all the biological rhythms scientists of the time, a number of whom are considered the founders of modern chronobiology. All aspects of biological rhythms were addressed, from the properties of circadian rhythms to their practical and ecological aspects. Birth of chronobiology dates from this period, with the definition of its vocabulary and specificities in metabolism, photoperiodism, animal physiology, etc. At around the same time, and right up to the present day, research has focused on melatonin, the circadian neurohormone of the pineal gland, with data on its pattern, metabolism, control by light and clinical applications. However, light has a double face, as it has positive effects as a circadian clock entraining agent, but also deleterious effects, as it can lead to chronodisruption when exposed chronically at night, which can increase the risk of cancer and other diseases. Finally, research over the past few decades has unraveled the anatomical location of circadian clocks and their cellular and molecular mechanisms. This recent research has in turn allowed us to explain how circadian rhythms control physiology and health.
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Affiliation(s)
- Yvan Touitou
- Unité de Chronobiologie, Fondation A. de Rothschild, Paris, France
| | - Nicolas Cermakian
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
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Mori K, Komatsu T, Fujiwara Y, Fujita Y. Comparison of the Effects of Desflurane and Sevoflurane on Variations in Salivary Melatonin and Sleep Disturbance After Total Knee Arthroplasty: A Single-center, Prospective, Randomized, Controlled, Open-label Study. J Perianesth Nurs 2024; 39:101-108. [PMID: 37791946 DOI: 10.1016/j.jopan.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/22/2023] [Accepted: 07/16/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Anesthesia has been shown to disrupt the circadian rhythm. Recovery of the circadian rhythm after general anesthesia might help alleviate symptoms of insomnia and postoperative delirium. We hypothesized that recovery of the circadian rhythm is faster after total knee arthroplasty (TKA) with desflurane than with sevoflurane. This study compared the influence of sevoflurane versus desflurane anesthesia on the postoperative circadian rhythm of melatonin in adults undergoing TKA. DESIGN Single-center, prospective, randomized, controlled, open-label study. METHODS This study involved adult patients undergoing TKA at a university hospital in Japan from May 1, 2018 to December 31, 2019. The primary outcome of the study was the comparison of the effect of sevoflurane and desflurane on the circadian rhythm of salivary melatonin for 3 days postoperatively. The secondary outcomes were postoperative fatigue and sleep quality for 3 days postoperatively. FINDINGS Twenty-eight patients (American Society of Anesthesiologists physical status of I or II) were scheduled for TKA and randomized to receive sevoflurane (n = 14) or desflurane (n = 14) anesthesia. There was no significant difference in the melatonin concentration between the sevoflurane and desflurane groups. The salivary melatonin concentration after sevoflurane or desflurane anesthesia was significantly higher at 9:00 p.m. on a postoperative day (POD)0 and POD1 than on POD3 (P < .05). Patients in the desflurane group had significantly greater fatigue than those in the sevoflurane group at 7:00 a.m. and 12:00 p.m. on POD3 (P < .05). Patients in the sevoflurane group had a deeper sleep than those in the desflurane group on POD0 (P < .05). In the sevoflurane group, the sleep time during the night of POD2 was longer than that on POD0 (6.1 vs 4.2 hours, P < .05). CONCLUSIONS Under the current study conditions, desflurane was equivalent to sevoflurane in terms of the postoperative salivary melatonin concentration and sleep disturbance after TKA but not in terms of recovering the postoperative circadian rhythm.
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Affiliation(s)
- Kazunao Mori
- Nurse Practitioner Office, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
| | - Toru Komatsu
- Department of Anesthesiology, Aichi Medical University, Nagakute, Aichi, Japan
| | | | - Yoshihito Fujita
- Department of Anesthesiology, Aichi Medical University, Nagakute, Aichi, Japan
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Coste O, Touitou Y. Hypoxia treatment of Parkinson's disease may disrupt the circadian system. BMC Neurol 2023; 23:234. [PMID: 37337177 DOI: 10.1186/s12883-023-03270-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Affiliation(s)
- Olivier Coste
- Hôpital d'Instruction des Armées, Pathologie du Sommeil, Lyon, France
| | - Yvan Touitou
- Unité de Chronobiologie, Fondation Rothschild, 75019, Paris, France.
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Progress in modelling of brain dynamics during anaesthesia and the role of sleep-wake circuitry. Biochem Pharmacol 2021; 191:114388. [DOI: 10.1016/j.bcp.2020.114388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/28/2022]
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Song Y, Liu Y, Yuan Y, Jia X, Zhang W, Wang G, Jia Y, Wang X, Liu L, Li W, Li X, Cai N, Liu C, Li Y, Han Y, Zhou Y, Mi X, Shi C, Wang JQ, Vuylsteke A, Guo X, Li Z. Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial. EBioMedicine 2021; 70:103490. [PMID: 34280784 PMCID: PMC8318871 DOI: 10.1016/j.ebiom.2021.103490] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Circadian rhythm disturbance is common postoperatively in older patients with hip fractures, which may contribute to the development of postoperative delirium (POD). As a reliable biomarker of endogenous circadian rhythms, melatonin regulates the sleep-wake cycle and environmental adaptation, and its secretory rhythm may be modified by anaesthesia and surgery. This study compared the impact of subarachnoid anaesthesia (SA) and general anaesthesia (GA), on the peak of melatonin secretion (primary outcome), the circadian rhythm of melatonin, cortisol and sleep, and the POD incidence (secondary outcome). METHODS In this prospective cohort observational study, hip fracture surgery patients were enrolled and assigned to receive either SA or GA. Postoperative plasma melatonin and cortisol levels were dynamically measured every six hours on seven time-points, and the circadian rhythm parameters including mesor, amplitude, and acrophase were calculated. Subjective and objective sleep assessments were performed by sleep diaries and sleep trackers, respectively. The Confusion Assessment Method was used twice daily by a specific geriatrician to screen for POD occurrence. FINDINGS In a cohort of 138 patients who underwent hip fracture surgery, the circadian rhythm disruption of the patients in the GA group (n=69) was greater than the SA group (n=69). Compared with SA, GA provided the lower peak concentration, mesor, and amplitude of melatonin secretion on postoperative day 1 (p < 0.05). Patients in the GA group experienced higher awakenings, more sleep deprivation, and poor sleep quality on surgery day (p < 0.05). A proportion of 12 patients in the SA group (17.4%) and 24 patients in the GA group (34.8%) experienced POD (p = 0.020). INTERPRETATION These results suggest that SA may be superior to GA in elderly patients undergoing hip fracture surgery as SA is associated with less impairment of the melatonin rhythm and sleep patterns, and fewer POD occurrences. FUNDING The study was supported by the National Natural Science Foundation of China (81971012, 81873726, 81901095, 81701052, and 81801070), Key Clinical Projects of Peking University Third Hospital (BYSYZD2019027), and Peking University "Clinical Medicine plus X" Youth Project (PKU2020LCXQ016).
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Affiliation(s)
- Yanan Song
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Yajie Liu
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Yi Yuan
- Department of Anesthesiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Xixi Jia
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Wenchao Zhang
- Department of Anesthesiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Geng Wang
- Department of Anesthesiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yunyang Jia
- Department of Orthopaedics & Traumatology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Xiaoxiao Wang
- Department of Research Center of Clinical Epidemiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Lei Liu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Shandong University, Shandong 250012, China
| | - Weitian Li
- College of Veterinary Medicine, China Agricultural University, No.2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China
| | - Xinping Li
- Department of Geriatrics, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Nan Cai
- Department of Anesthesiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Chang Liu
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Yue Li
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Xinning Mi
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - Chengmei Shi
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
| | - John Q Wang
- Department of Anesthesiology, University of Missouri Kansas City, School of Medicine, Kansas 64110, MO, USA
| | - Alain Vuylsteke
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, CB2 0AY Cambridge, UK
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China.
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China.
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Yuan Y, Song Y, Wang G, Jia Y, Zhou Y, Mi X, Jia X, Wang X, Liu C, Li Y, Shi C, Han Y, Guo X, Zhang W, Li Z. Effects of general versus regional anaesthesia on circadian melatonin rhythm and its association with postoperative delirium in elderly patients undergoing hip fracture surgery: study protocol for a prospective cohort clinical trial. BMJ Open 2021; 11:e043720. [PMID: 33579771 PMCID: PMC7883867 DOI: 10.1136/bmjopen-2020-043720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Postoperative delirium (POD) is a common neurological complication after hip fracture surgery and is associated with high morbidity and mortality in elderly patients. Although the specific mechanism of POD remains unclear, circadian rhythm disruptions have recently drawn increased attention. To date, only limited postoperative time points of plasma melatonin level measurements were recorded in previous studies, and such data cannot represent a comprehensive melatonin rhythm. The process of anaesthesia (either general anaesthesia (GA) or regional anaesthesia (RA)) is known to influence the melatonin rhythm. However, how these two anaesthesia methods differently affect the postoperative melatonin rhythm is still unknown. Therefore, we hypothesise that RA may attenuate the disruption of the melatonin rhythm, which might decrease the incidence of POD in elderly patients undergoing hip surgery. METHODS AND ANALYSIS In this prospective cohort clinical trial, 138 patients scheduled for hip fracture surgery will be divided into two groups to receive either GA or RA. The primary aim is to compare the circadian rhythm of melatonin secretion between the two groups and explore its association with the incidence of POD. ETHICS AND DISSEMINATION The study has been approved by the Medical Science Research Ethics Committees of Beijing Jishuitan Hospital (JLKS201901-04). The results of the study will be published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER ChiCTR1900027393.
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Affiliation(s)
- Yi Yuan
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yanan Song
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Geng Wang
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yunyang Jia
- Department of Orthopaedics & Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xinning Mi
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xixi Jia
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Chang Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yue Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Chengmei Shi
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Wenchao Zhang
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
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Touitou Y, Point S. Effects and mechanisms of action of light-emitting diodes on the human retina and internal clock. ENVIRONMENTAL RESEARCH 2020; 190:109942. [PMID: 32758719 DOI: 10.1016/j.envres.2020.109942] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/29/2020] [Accepted: 07/10/2020] [Indexed: 05/11/2023]
Abstract
White light-emitting diodes (LEDs) will likely become the most used lighting devices worldwide in the future because of their very low prices over the course of their long lifespans which can be up to several tens of thousands of hours. The expansion of LED use in both urban and domestic lighting has prompted questions regarding their possible health effects, because the light that they provide is potentially high in the harmful blue band (400-500 nm) of the visible light spectrum. Research on the potential effects of LEDs and their blue band on human health has followed three main directions: 1) examining their retinal phototoxicity; 2) examining disruption of the internal clock, i.e., an out-of-sync clock, in shift workers and night workers, including the accompanying health issues, most concerningly an increased relative risk of cancer; and 3) examining risky, inappropriate late-night use of smartphones and consoles among children and adolescents. Here, we document the recognized or potential health issues associated with LED lighting together with their underlying mechanisms of action. There is so far no evidence that LED lighting is deleterious to human retina under normal use. However, exposure to artificial light at night is a new source of pollution because it affects the circadian clock. Blue-rich light, including cold white LEDs, should be considered a new endocrine disruptor, because it affects estrogen secretion and has unhealthful consequences in women, as demonstrated to occur via a complex mechanism.
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Affiliation(s)
- Yvan Touitou
- Unité de Chronobiologie, Fondation A. de Rothschild, 75019, Paris, France.
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Imai R, Makino H, Katoh T, Kimura T, Kurita T, Hokamura K, Umemura K, Nakajima Y. Desflurane anesthesia shifts the circadian rhythm phase depending on the time of day of anesthesia. Sci Rep 2020; 10:18273. [PMID: 33106509 PMCID: PMC7588451 DOI: 10.1038/s41598-020-75434-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/12/2020] [Indexed: 11/09/2022] Open
Abstract
Desflurane is one of the most frequently used inhalational anesthetics in clinical practice. A circadian rhythm phase-shift after general anesthesia with sevoflurane or isoflurane has been reported in mice, but few studies have reported this effect with desflurane. In the present study, we examined the rest/activity rhythm of mice by counting the number of running wheel rotations, and we found that desflurane anesthesia caused a phase shift in the circadian rhythm that was dependent on the time of day of anesthesia. We also found that desflurane anesthesia altered the relative mRNA expression of four major clock genes (Per2, Bmal, Clock, and Cry1) in the suprachiasmatic nucleus (SCN). These results are important for elucidating the effects of desflurane on the SCN, which is the master clock for the mammalian circadian rhythm. Further studies on the relationship between anesthesia and circadian rhythm may lead to the prevention and treatment of postoperative complications related to circadian rhythms.
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Affiliation(s)
- Ryo Imai
- Department of Anesthesiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Hiroshi Makino
- Department of Anesthesiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Takasumi Katoh
- Department of Anesthesiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tetsuro Kimura
- Department of Anesthesiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tadayoshi Kurita
- Department of Anesthesiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kazuya Hokamura
- Department of Medical Education, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuo Umemura
- Department of Pharmacology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3192, Japan
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Luo M, Song B, Zhu J. Sleep Disturbances After General Anesthesia: Current Perspectives. Front Neurol 2020; 11:629. [PMID: 32733363 PMCID: PMC7360680 DOI: 10.3389/fneur.2020.00629] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
The purpose of this article is to review (1) sleep mechanism under general anesthesia, harmful effects of postoperative sleep disturbances; (2) risk factors associated with postoperative sleep disturbances; (3) measures to prevent and improve postoperative sleep disturbances. General anesthesia changes the postoperative sleep structure especially in elderly patients after major surgery and results in a high incidence rate of sleep disturbances. Sleep disturbances produce harmful effects on postoperative patients and lead to a higher risk of delirium, more cardiovascular events, and poorer recovery. Some researchers do propose non-pharmacological treatments such as attention to environmental and psychological factors, application of electroacupuncture (EA) technology and pharmacological treatments are helpful, but larger high-quality clinical trials with longer following-up are needed to further investigate the efficacy and safety.
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Affiliation(s)
- Man Luo
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Anesthesiology, Friendship Hospital of Capital Medical University, Beijing, China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
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Kelleci Çelik F, Charehsaz M, Aydin A. Toxicological evaluation of the interaction between circadian rhythm activator; KL001 and general anesthetic; isoflurane. BIOL RHYTHM RES 2019. [DOI: 10.1080/09291016.2019.1698808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Feyza Kelleci Çelik
- Department of Pharmaceutical Toxicology, Sağlık Bilimleri University Faculty of Pharmacy, İstanbul, Turkey
| | - Mohammad Charehsaz
- Department of Pharmaceutical Toxicology, Yeditepe University Faculty of Pharmacy, Istanbul, Turkey
| | - Ahmet Aydin
- Department of Pharmaceutical Toxicology, Yeditepe University Faculty of Pharmacy, Istanbul, Turkey
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Svorc P, Petrasova D, Svorc Jr P. Chronobiological study of sex differences in the internal environment in zoletil-anaesthetized rats. BIOL RHYTHM RES 2019. [DOI: 10.1080/09291016.2018.1564577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Pavol Svorc
- Department of Physiology, Medical Faculty Safarik’s University, Kosice, Slovak Republic
- Department of Physiology and Pathophysiology, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Darina Petrasova
- Laboratory of Research Bio-models, Medical Faculty Safarik’s University, Kosice, Slovak Republic
| | - Pavol Svorc Jr
- Department of Physiology and Pathophysiology, Medical Faculty, Ostrava University, Ostrava, Czech Republic
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SVORC P, PETRÁŠOVÁ D, SVORC P. Arterial pH and Blood Gas Values in Rats Under Three Types of General Anesthesia: a Chronobiological Study. Physiol Res 2018; 67:721-728. [DOI: 10.33549/physiolres.933692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of study was to review the status of arterial pH, pO2 and pCO2 under general anesthesias in dependence on the light-dark (LD) cycle in spontaneously breathing rats. The experiments were performed using three- to four-month-old pentobarbital(P)-, ketamine/xylazine(K/X)- and zoletil(Z)-anesthetized female Wistar rats after a four-week adaptation to an LD cycle (12 h light:12 h dark). The animals were divided into three experimental groups according to the anesthetic agent used: P (light n=11; dark n=8); K/X (light n=13; dark n=11); and Z (light n=18; dark n=26). pH and blood gases from arterial blood were analyzed. In P anesthesia, LD differences in pH, pO2, and pCO2 were eliminated. In K/X anesthesia, parameters showed significant LD differences. In Z anesthesia, LD differences were detected for pH and pO2 only. Acidosis, hypoxia, and hypercapnia have been reported for all types of anesthesia during the light period. In the dark period, except for P anesthesia, the environment was more stable and values fluctuated within normal ranges. From a chronobiological perspective, P anesthesia was not the most appropriate type of anesthesia in these rat experiments. It eliminated LD differences, and also produced a more acidic environment and more pronounced hypercapnia than K/X and Z anesthesias.
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Affiliation(s)
- P. SVORC
- Department of Physiology, Medical Faculty Safarik’s University, Kosice, Slovak Republic
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Szolnoki J, Polaner DM, Eckle T. Diurnal variations in recovery times after general anaesthesia in children. Br J Anaesth 2018; 121:776-786. [PMID: 30236240 PMCID: PMC6617965 DOI: 10.1016/j.bja.2018.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Circadian rhythms coordinate almost all physiological functions and are implicated in major disease development. Even though circadian rhythms have a major impact on human health, little is known about how they affect general anaesthesia. The purpose of this study was to understand if the time of day affects the length of time a child needs to achieve readiness for discharge after general anaesthesia for brain MRI. METHODS A retrospective analysis over a 3 yr period (2013-5) on the length of stay in the postanaesthesia care unit (PACU) before discharge was performed for children (age <18 yr) undergoing brain magnetic resonance imaging as outpatients. PACU duration was correlated to either morning vs afternoon or to time clusters for discharge times (<9 AM, >9 AM <12 PM, >12 PM <3 PM, >3 PM <6 PM, >6 PM). RESULTS Data from 2340 procedures in children, with median age [inter-quartile range (range)] of 4.7 [2.3-7.25 (0.5-17.8)] yr were available for analysis. The length of stay in the PACU significantly increased over the course of the day with an observed maximum increase of 18 or 19 min (<9 AM vs >6 PM) in children older than 3 or 5 yr, respectively. Subgroup analysis suggested time of day dependent PACU time increase was independent of sex, co-medications, or obstructive sleep apnoea. CONCLUSION The time of day significantly affects PACU recovery times in children of both genders having brain imaging under general anaesthesia. Children younger than 3 yr might not be affected. Further validation of these findings may guide future strategies to reduce discharge times.
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Affiliation(s)
- J Szolnoki
- Department of Anaesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA; Department of Anaesthesiology, Children's Hospital Colorado, Aurora, CO, USA
| | - D M Polaner
- Department of Anaesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA; Department of Anaesthesiology, Children's Hospital Colorado, Aurora, CO, USA
| | - T Eckle
- Department of Anaesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
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Saravanan B, Kundra P, Mishra SK, Surianarayanan G, Parida PK. Effect of anaesthetic agents on olfactory threshold and identification - A single blinded randomised controlled study. Indian J Anaesth 2018; 62:592-598. [PMID: 30166653 PMCID: PMC6100266 DOI: 10.4103/ija.ija_245_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Anaesthetics are implicated in cognitive dysfunction, taste and odour deficits in the postoperative period. We aimed to assess the effect of isoflurane, sevoflurane, propofol and regional anaesthesia on the olfactory threshold, olfactory identification and endocrine regulation of associative memory in the postoperative period. Methods: In this observer-blinded randomised controlled study, 164 patients (>50 years) with the American Society of Anesthesiologists I and II status were randomised into one of four groups to receive regional anaesthesia, general anaesthesia with sevoflurane, general anaesthesia with isoflurane and total intravenous anaesthesia with propofol. Hindi Mental State Examination, olfactory threshold and olfactory identification were tested at 12 h preoperatively (T0), at 3 h postoperatively (T1) and at the time of discharge or postoperative day 3 (T2). In addition, serum melatonin levels were estimated at T0 and T1. The olfactory threshold was tested with n-butyl alcohol and olfactory identification with the University of Pennsylvania Smell Identification Test (UPSIT). Data were analysed using the one-way analysis of variance, Kruskal-Wallis or Mann-whitney tests. Results: The olfactory identification scores were lower with patients receiving sevoflurane-based anaesthesia at 3 h postoperatively (T1) when compared to preoperative (T0) (median 19.5 vs. 22; P = 0.01). This was accompanied by a significant postoperative reduction of plasma melatonin levels in sevoflurane group when compared to other groups (17.34 ± 4.8 pg/ml vs 23.2 ± 3.5 pg/ml; P < 0.001). Conclusion: Sevoflurane was associated with short-term olfactory identification impairment with a concomitant reduction in melatonin levels illustrating a possible humoral mechanism.
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Affiliation(s)
- Balachandar Saravanan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandeep Kumar Mishra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gopalakrishnan Surianarayanan
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pradipta Kumar Parida
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Svorc P, Bacova I, Gresova S, Svorc P. Chronobiological perspectives on myocardial electrophysiological parameters under three types of general anaesthesia in a rat model. BIOL RHYTHM RES 2016. [DOI: 10.1080/09291016.2016.1263003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pavol Svorc
- Medical Faculty, Department of Physiology, Safarik’s University, Kosice, Slovak Republic
| | - Ivana Bacova
- Medical Faculty, Department of Physiology, Safarik’s University, Kosice, Slovak Republic
| | - Sona Gresova
- Medical Faculty, Department of Physiology, Safarik’s University, Kosice, Slovak Republic
| | - Pavol Svorc
- Medical Faculty, Department of Physiology and Patophysiology, Ostrava University, Ostrava, Czech Republic
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Svorc P, Svorc P, Bacova I, Gresova S. Thoughts on anaesthesia in chronobiological studies with electrocardiograms. Acta Physiol (Oxf) 2016; 218:71-2. [PMID: 26990652 DOI: 10.1111/apha.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P. Svorc
- Medical Faculty; Department of Physiology; Safarik University; Kosice Slovakia
| | - P. Svorc
- Medical Faculty; Department of Physiology and Pathophysiology; Ostrava University; Ostrava Czech Republic
| | - I. Bacova
- Medical Faculty; Department of Physiology; Safarik University; Kosice Slovakia
| | - S. Gresova
- Medical Faculty; Department of Physiology; Safarik University; Kosice Slovakia
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Duclos C, Dumont M, Potvin MJ, Desautels A, Gilbert D, Menon DK, Bernard F, Gosselin N. Evolution of severe sleep-wake cycle disturbances following traumatic brain injury: a case study in both acute and subacute phases post-injury. BMC Neurol 2016; 16:186. [PMID: 27677675 PMCID: PMC5039911 DOI: 10.1186/s12883-016-0709-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Sleep-wake disturbances are frequently reported following traumatic brain injury (TBI), but they remain poorly documented in the acute stage of injury. Little is known about their origin and evolution. Case presentation This study presents the case of a patient in the acute phase of a severe TBI. The patient was injured at work when falling 12 m into a mine and was hospitalized in the regular wards of a level I trauma centre. From days 31 to 45 post-injury, once he had reached a level of medical stability and continuous analgosedation had been ceased, his sleep-wake cycle was monitored using actigraphy. Results showed significant sleep-wake disturbances and severe sleep deprivation. Indeed, the patient had an average nighttime sleep efficiency of 32.7 ± 15.4 %, and only an average of 4.8 ± 1.3 h of sleep per 24-h period. After hospital discharge to the rehabilitation centre, where he remained for 5 days, the patient was readmitted to the same neurological unit for paranoid delusions. During his second hospital stay, actigraphy recordings resumed from days 69 to 75 post-injury. A major improvement in his sleep-wake cycle was observed during this second stay, with an average nighttime sleep efficiency of 96.3 ± 0.9 % and an average of 14.1 ± 0.9 h of sleep per 24-h period. Conclusion This study is the first to extensively document sleep-wake disturbances in both the acute and subacute phases of severe TBI. Results show that prolonged sleep deprivation can be observed after TBI, and suggest that the hospital environment only partially contributes to sleep-wake disturbances. Continuous actigraphic monitoring may prove to be a useful clinical tool in the monitoring of patients hospitalized after severe TBI in order to detect severe sleep deprivation requiring intervention. The direct impact of sleep-wake disturbances on physiological and cognitive recovery is not well understood within this population, but is worth investigating and improving. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0709-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Duclos
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, local E-0300, Montréal, Québec, H4J 1C5, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Marie Dumont
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, local E-0300, Montréal, Québec, H4J 1C5, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Marie-Julie Potvin
- Traumatology program, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, local E-0300, Montréal, Québec, H4J 1C5, Canada.,Department of Neuroscience, Université de Montreal, Montréal, Canada
| | - Danielle Gilbert
- Traumatology program, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Department of Radiology, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin Ouest, local E-0330, Montréal, Québec, H4J 1C5, Canada
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Box 93, Cambridge, CB2 2QQ, UK
| | - Francis Bernard
- Traumatology program, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Department of Medicine, Université de Montreal, Montréal, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, local E-0300, Montréal, Québec, H4J 1C5, Canada. .,Department of Psychology, Université de Montréal, Montréal, Canada.
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Touitou Y, Mauvieux B, Reinberg A, Dispersyn G. Disruption of the circadian period of body temperature by the anesthetic propofol. Chronobiol Int 2016; 33:1247-1254. [DOI: 10.1080/07420528.2016.1208664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Yvan Touitou
- Unité de Chronobiologie, Fondation A. de Rothschild, Paris, France
| | - Benoit Mauvieux
- Unité de Chronobiologie, Fondation A. de Rothschild, Paris, France
- INSERM UMR U1075, Université de Caen, Caen, France
| | - Alain Reinberg
- Unité de Chronobiologie, Fondation A. de Rothschild, Paris, France
| | - Garance Dispersyn
- Institut de Recherche Biomédicale des Armées (IRBA), Brétigny sur Orge, France
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Smolensky MH, Hermida RC, Reinberg A, Sackett-Lundeen L, Portaluppi F. Circadian disruption: New clinical perspective of disease pathology and basis for chronotherapeutic intervention. Chronobiol Int 2016; 33:1101-19. [PMID: 27308960 DOI: 10.1080/07420528.2016.1184678] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Biological processes are organized in time as innate rhythms defined by the period (τ), phase (peak [Φ] and trough time), amplitude (A, peak-trough difference) and mean level. The human time structure in its entirety is comprised of ultradian (τ < 20 h), circadian (20 h > τ < 28 h) and infradian (τ > 28 h) bioperiodicities. The circadian time structure (CTS) of human beings, which is more complicated than in lower animals, is orchestrated and staged by a brain central multioscillator system that includes a prominent pacemaker - the suprachiasmatic nuclei of the hypothalamus. Additional pacemaker activities are provided by the pineal hormone melatonin, which circulates during the nighttime, and the left and right cerebral cortices. Under ordinary circumstances this system coordinates the τ and Φ of rhythms driven by subservient peripheral cell, tissue and organ clock networks. Cyclic environmental, feeding and social time cues synchronize the endogenous 24 h clocks and rhythms. Accordingly, processes and functions of the internal environment are integrated in time for maximum biological efficiency, and they are also organized and synchronized in time to the external environment to ensure optimal performance and response to challenge. Artificial light at night (ALAN) exposure can alter the CTS as can night work, which, like rapid transmeridian displacement by air travel, necessitates realignment of the Φ of the multitude of 24 h rhythms. In 2001, Stevens and Rea coined the phrase "circadian disruption" (CD) to label the CTS misalignment induced by ALAN and shift work (SW) as a potential pathologic mechanism of the increased risk for cancer and other medical conditions. Current concerns relating to the effects of ALAN exposure on the CTS motivated us to renew our long-standing interest in the possible role of CD in the etiopathology of common human diseases and patient care. A surprisingly large number of medical conditions involve CD: adrenal insufficiency; nocturia; sleep-time non-dipping and rising blood pressure 24 h patterns (nocturnal hypertension); delayed sleep phase syndrome, non-24 h sleep/wake disorder; recurrent hypersomnia; SW intolerance; delirium; peptic ulcer disease; kidney failure; depression; mania; bipolar disorder; Parkinson's disease; Smith-Magenis syndrome; fatal familial insomnia syndrome; autism spectrum disorder; asthma; byssinosis; cancers; hand, foot and mouth disease; post-operative state; and ICU outcome. Poorly conceived medical interventions, for example nighttime dosing of synthetic corticosteroids and certain β-antagonists and cyclic nocturnal enteral or parenteral nutrition, plus lifestyle habits, including atypical eating times and chronic alcohol consumption, also can be causal of CD. Just as surprisingly are the many proven chronotherapeutic strategies available today to manage the CD of several of these medical conditions. In clinical medicine, CD seems to be a common, yet mostly unrecognized, pathologic mechanism of human disease as are the many effective chronotherapeutic interventions to remedy it.
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Affiliation(s)
- Michael H Smolensky
- a Department of Biomedical Engineering , Cockrell School of Engineering, The University of Texas at Austin , Austin , TX , USA
| | - Ramon C Hermida
- b Bioengineering and Chronobiology Laboratories , Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo , Vigo , Spain
| | - Alain Reinberg
- c Unité de Chronobiologie , Fondation A de Rothschild , Paris , Cedex , France
| | - Linda Sackett-Lundeen
- d American Association for Clinical Chronobiology and Chronotherapeutics, Roseville , MN , USA
| | - Francesco Portaluppi
- e Hypertension Center, University Hospital S. Anna and Department of Medical Sciences , University of Ferrara , Ferrara , Italy
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Ocmen E, Erdost HA, Duru LS, Akan P, Cimrin D, Gokmen AN. Effect of day/night administration of three different inhalational anesthetics on melatonin levels in rats. Kaohsiung J Med Sci 2016; 32:302-5. [PMID: 27377842 DOI: 10.1016/j.kjms.2016.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022] Open
Abstract
The nocturnal peak of melatonin can be altered after anesthesia and surgery. We aimed to examine the melatonin levels during the day and night after anesthesia with three commonly used inhalational anesthetics. Forty-eight male Wistar albino rats were randomized into eight groups. Rats were administered anesthesia between 7:00 am and 1:00 pm (day groups) or 7:00 pm and 1:00 am (night groups) for 6 hours. At the end of the anesthesia, blood samples were collected for assessing melatonin levels. Mean values of melatonin levels after 6 hours of anesthesia during daytime were 43.17±12.95 for control, 59.79±27.83 for isoflurane, 50.75±34.28 for sevoflurane and 212.20±49.56 pg/mL for desflurane groups. The night groups' mean melatonin levels were 136.12±33.20 for control, 139.85±56.29 for isoflurane, 117.48±82.39 for sevoflurane and 128.70±44.63 pg/mL for desflurane groups. Desflurane anesthesia between 7:00 am and 1:00 pm significantly increased melatonin levels (p<0.001). Sevoflurane and desflurane anesthesia between 7:00 pm and 1:00 am decreased the melatonin levels but there were no significant differences (p=0.904 and p>0.99, respectively). Isoflurane anesthesia did not significantly change melatonin levels during day or night (p=0.718 and p>0.99, respectively). Our results demonstrate that during daytime desflurane anesthesia can alter melatonin levels. Altered melatonin rhythm following inhalational anesthesia can be related to sleep disorders observed after anesthesia.
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Affiliation(s)
- Elvan Ocmen
- Department of Anesthesiology, Dokuz Eylul University, Izmir, Turkey.
| | - Hale Aksu Erdost
- Department of Anesthesiology, Dokuz Eylul University, Izmir, Turkey
| | - Leyla S Duru
- Department of Anesthesiology, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Akan
- Department of Biochemistry, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Cimrin
- Department of Biochemistry, Dokuz Eylul University, Izmir, Turkey
| | - Ali N Gokmen
- Department of Anesthesiology, Dokuz Eylul University, Izmir, Turkey
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Establishment of an in vitro cell line experimental system for the study of inhalational anesthetic mechanisms. Neurosci Lett 2016; 620:163-8. [DOI: 10.1016/j.neulet.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 03/23/2016] [Accepted: 04/04/2016] [Indexed: 12/31/2022]
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Gao J, Yang C, Ding H, Zhang Y, Xue J, Cai Y. 2,2,2-Trichloroethanol lengthens the circadian period of Bmal1-driven circadian bioluminescence rhythms in U2OS cells. Biochem Biophys Res Commun 2015; 462:239-44. [PMID: 25956065 DOI: 10.1016/j.bbrc.2015.04.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/26/2015] [Indexed: 12/27/2022]
Abstract
2,2,2-Trichloroethanol (TCOH) is responsible for the pharmacological actions of chloral hydrate (CH), and is a major metabolite of trichloroethylene. Human exposure to TCOH is known to be increasing. Recently, it was reported that TCOH causes a significant phase delay of Per2 expression in mouse liver when injected daily over the course of several days. However, it is not clear whether TCOH directly modulates the molecular clock. In the present study we used a cell-based assay system to test this possibility. We found that the daily oscillation period of Bmal1 was lengthened to 3 h following treatment with 1.5 mM TCOH, and increased to 5 h with 3 mM TCOH treatment. However, low concentrations of TCOH had no noticeable effects. The effect of TCOH on Per2 oscillation was marginal. Interestingly, serum from rats anesthetized with CH also modulated Bmal1 period, suggesting that exposure to anesthesia should be taken into consideration for circadian rhythm studies. In summary, our study reveals a direct regulation of TCOH on molecular clock.
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Affiliation(s)
- Jie Gao
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, PR China
| | - Caixia Yang
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, PR China
| | - Hui Ding
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, PR China
| | - Yanli Zhang
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, PR China
| | - Jinhua Xue
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, PR China
| | - Yanning Cai
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, Parkinson's Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, PR China.
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Melatonin treatment in the prevention of postoperative delirium in cardiac surgery patients. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:126-33. [PMID: 26336494 PMCID: PMC4550034 DOI: 10.5114/kitp.2015.52853] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/22/2015] [Accepted: 05/25/2015] [Indexed: 12/17/2022]
Abstract
Introduction Post-cardiac surgery delirium is a severe complication. The circadian rhythm of melatonin secretion has been shown to be altered postoperatively. Aim of the study It was hypothesized that restoring normal sleeping patterns with a substance that is capable of resynchronizing circadian rhythm such as exogenous administration of melatonin may possibly reduce the incidence of postoperative delirium. Material and methods This paper represents a prospective clinical observational study. Two consecutive groups of 250 consecutive patients took part in the study. Group A was the control group and group B was the melatonin group. In group B, the patients received prophylactic melatonin treatment. The main objectives were to observe the incidence of delirium, to identify any predictors of delirium, and to compare the two groups based on the delirium incidence. Results The incidence of delirium was 8.4% in the melatonin group vs. 20.8% in the control group (p = 0.001). Predictors of delirium in the melatonin group were age (p = 0.001) and higher EuroSCORE II value (p = 0.001). In multivariate analysis, age and EuroSCORE II value (p = 0.014) were predictors of postoperative delirium. Comparing the groups, the main predictors of delirium were age (p = 0.001), EuroSCORE II value (p = 0.001), cardio-pulmonary bypass (CPB) time (p = 0.001), aortic cross-clamping (ACC) time (p = 0.008), sufentanil dose (p = 0.001) and mechanical ventilation (p = 0.033). Conclusions Administration of melatonin significantly decreases the incidence of postoperative delirium after cardiac surgery. Prophylactic treatment with melatonin should be considered in every patient scheduled for cardiac surgery.
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Svorc P, Svorc P, Bacova I, Gresova S. Pentobarbital anaesthesia in the chronobiological studies. BIOL RHYTHM RES 2015. [DOI: 10.1080/09291016.2015.1020202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brainard J, Gobel M, Bartels K, Scott B, Koeppen M, Eckle T. Circadian rhythms in anesthesia and critical care medicine: potential importance of circadian disruptions. Semin Cardiothorac Vasc Anesth 2014; 19:49-60. [PMID: 25294583 DOI: 10.1177/1089253214553066] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The rotation of the earth and associated alternating cycles of light and dark--the basis of our circadian rhythms--are fundamental to human biology and culture. However, it was not until 1971 that researchers first began to describe the molecular mechanisms for the circadian system. During the past few years, groundbreaking research has revealed a multitude of circadian genes affecting a variety of clinical diseases, including diabetes, obesity, sepsis, cardiac ischemia, and sudden cardiac death. Anesthesiologists, in the operating room and intensive care units, manage these diseases on a daily basis as they significantly affect patient outcomes. Intriguingly, sedatives, anesthetics, and the intensive care unit environment have all been shown to disrupt the circadian system in patients. In the current review, we will discuss how newly acquired knowledge of circadian rhythms could lead to changes in clinical practice and new therapeutic concepts.
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Affiliation(s)
| | - Merit Gobel
- University of Colorado Denver, Aurora, CO, USA
| | | | | | - Michael Koeppen
- University of Colorado Denver, Aurora, CO, USA Ludwig-Maximilians-University, Munich, Germany
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Sleep and wake disturbances following traumatic brain injury. ACTA ACUST UNITED AC 2014; 62:252-61. [DOI: 10.1016/j.patbio.2014.05.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/13/2014] [Indexed: 01/16/2023]
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Teilmann AC, Kalliokoski O, Jacobsen KR, Hau J, Abelson KSP. Impact of heparin and short term anesthesia on the quantification of cytokines in laboratory mouse plasma. Acta Vet Scand 2014; 56:33. [PMID: 24884817 PMCID: PMC4041355 DOI: 10.1186/1751-0147-56-33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/14/2014] [Indexed: 12/02/2022] Open
Abstract
Background Studies have reported that heparin may be unsuitable as an anticoagulant in human plasma samples when quantifying cytokines using multiplex bead array assays. For mouse samples, multiplex assays have been validated for serum and EDTA-plasma, but it remains to be elucidated whether heparin influences the quantification of cytokines, and if so – to what extent. Furthermore, laboratory mice are often anesthetized for blood sampling, which causes acute stress that may influence circulating cytokine concentrations and thus bias experimental results. The objectives of the present study were to identify whether specific cytokine concentrations varied between heparin-plasma, serum, and EDTA-plasma, and whether short isoflurane anesthesia would influence the concentrations of these cytokines in the circulation. Twenty-three acute phase and pro-inflammatory cytokines were quantified in matched serum, EDTA-plasma, and heparin-plasma samples from anesthetized and unanesthetized male NMRI mice using a multiplex assay. In addition, samples from unanesthetized mice were spiked with three levels of heparin. Results The concentrations of five out of 23 cytokines were significantly different between sample types, but only one cytokine (IL-17A) differed between heparin-plasma and serum. When further spiking the heparin-plasma with increasing concentrations of heparin, there was a significant effect on 11 cytokines, where the cytokine recovery could be correlated to the heparin concentration for ten of these cytokines. Anesthesia resulted in lower concentrations of G-CSF, but had no significant impact on the concentrations of the other 22 cytokines. Conclusion In mice, heparin seems like a suitable anticoagulant for obtaining plasma for multiplex assays for the cytokines IL-1α, IL-1β, IL-2, IL-6, IL-9, IL-12p40, IL-12p70, IL-13, G-CSF, GM-CSF, IFN-γ, KC, MCP-1, MIP-1α, MIP-1β, RANTES and TNFα, but an effect of heparin in high concentrations should be considered for the cytokines IL-9, IL-12p40, IL-12p70, KC, MCP-1, MIP-1β and RANTES. Short isoflurane anesthesia had significant impact on G-CSF, but none of the other cytokines.
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The influence of the time of day on midazolam pharmacokinetics and pharmacodynamics in rabbits. Pharmacol Rep 2014; 66:143-52. [PMID: 24905320 DOI: 10.1016/j.pharep.2013.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 06/05/2013] [Accepted: 06/20/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study evaluates the time-of-day effect on midazolam and 1-OH midazolam pharmacokinetics, and on the sedative pharmacodynamic response in rabbits. Also, circadian fluctuations in rabbits' vital signs, such as the blood pressure, heart rate and body temperature were examined. The water intake was measured in order to confirm the presence of the animals' diurnal activity. The secondary aim involved the comparison of two methods of data analysis: a noncompartmental and a population modeling approach. METHODS Twelve rabbits were sedated with intravenous midazolam 0.35 mg/kg at four local times: 09.00, 14.00, 18.00 and 22.00 h. Each rabbit served as its own control by being given a single infusion at the four different times of the day on four separate occasions. The values of the monitored physiological parameters were recorded during the experiment and arterial blood samples were collected for midazolam assay. The pedal withdrawal reflex was used as the measurement of the sedation response. Two and one compartmental models were successfully used to describe midazolam and 1-OH midazolam pharmacokinetics. The categorical pharmacodynamic data were described with a logistic model. RESULTS AND CONCLUSIONS We did not find any time-of-day effects for the pharmacokinetic and pharmacodynamics parameters of midazolam. For 1-OH midazolam, statistically significant time-of-day differences in the apparent volume of distribution and clearance were noticed. They corresponded well with the rabbits' water intake. The noncompartmental and model-based parameters were essentially similar. However, more information can be obtained from the population model and this method should be preferred in chronopharmacokinetic and chronopharmacodynamic studies.
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Duclos C, Dumont M, Blais H, Paquet J, Laflamme E, de Beaumont L, Wiseman-Hakes C, Menon DK, Bernard F, Gosselin N. Rest-Activity Cycle Disturbances in the Acute Phase of Moderate to Severe Traumatic Brain Injury. Neurorehabil Neural Repair 2013; 28:472-82. [DOI: 10.1177/1545968313517756] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background. Sleep-wake disturbances are among the most persistent sequelae after traumatic brain injury (TBI) and probably arise during the hospital stay following TBI. These disturbances are characterized by difficulties sleeping at night and staying awake during the day. Objective. The aim of the present study was to document rest-activity cycle consolidation in acute moderate/severe TBI using actigraphy and to assess its association with injury severity and outcome. Methods. In all, 16 hospitalized patients (27.1 ± 11.3 years) with moderate/severe TBI wore actigraphs for 10 days, starting in the intensive care unit (ICU) when continuous sedation was discontinued and patients had reached medical stability. Activity counts were summed for daytime (7:00-21:59 hours) and nighttime periods (22:00-6:59 hours). The ratio of daytime period activity to total 24-hour activity was used to quantify rest-activity cycle consolidation. An analysis of variance was carried out to characterize the evolution of the daytime activity ratio over the recording period. Results. Rest-activity cycle was consolidated only 46.6% of all days; however, a significant linear trend of improvement was observed over time. Greater TBI severity and longer ICU and hospital lengths of stay were associated with poorer rest-activity cycle consolidation and evolution. Patients with more rapid return to consolidated rest-activity cycle were more likely to have cleared posttraumatic amnesia and have lower disability at hospital discharge. Conclusions. Patients with acute moderate/severe TBI had an altered rest-activity cycle, probably reflecting severe fragmentation of sleep and wake episodes, which globally improved over time. A faster return to rest-activity cycle consolidation may predict enhanced brain recovery.
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Affiliation(s)
- Catherine Duclos
- Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Marie Dumont
- Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Hélène Blais
- Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| | - Jean Paquet
- Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| | | | - Louis de Beaumont
- Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Catherine Wiseman-Hakes
- Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | | | - Francis Bernard
- Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Nadia Gosselin
- Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
- Université de Montréal, Montréal, Canada
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Touitou Y. Adolescent sleep misalignment: a chronic jet lag and a matter of public health. ACTA ACUST UNITED AC 2013; 107:323-6. [DOI: 10.1016/j.jphysparis.2013.03.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kikuchi T, Tan H, Mihara T, Uchimoto K, Mitsushima D, Takase K, Morita S, Goto T, Andoh T, Kamiya Y. Effects of volatile anesthetics on the circadian rhythms of rat hippocampal acetylcholine release and locomotor activity. Neuroscience 2013; 237:151-60. [DOI: 10.1016/j.neuroscience.2013.01.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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Kadota K, Iijima N, Ohe-Hayashi Y, Takumi K, Higo S, Sakamoto A, Ozawa H. Time-dependent repression of mPer2 expression in the suprachiasmatic nucleus by inhalation anesthesia with sevoflurane. Neurosci Lett 2012; 528:153-8. [DOI: 10.1016/j.neulet.2012.07.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/19/2012] [Accepted: 07/27/2012] [Indexed: 01/10/2023]
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Bienert A, Płotek W, Zawidzka I, Ratajczak N, Szczesny D, Wiczling P, Kokot ZJ, Matysiak J, Grześkowiak E. Influence of Time of Day on Propofol Pharmacokinetics and Pharmacodynamics in Rabbits. Chronobiol Int 2011; 28:318-29. [DOI: 10.3109/07420528.2011.560317] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sánchez-Vázquez FJ, Terry MI, Felizardo VO, Vera LM. Daily Rhythms of Toxicity and Effectiveness of Anesthetics (MS222 and Eugenol) in Zebrafish (Danio Rerio). Chronobiol Int 2011; 28:109-17. [DOI: 10.3109/07420528.2010.538105] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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[Ambulatory Essure implant placement sterilization procedure for women: prospective study comparing general anesthesia versus hypnosis combined with sedation]. ACTA ACUST UNITED AC 2010; 29:889-96. [PMID: 21112724 DOI: 10.1016/j.annfar.2010.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Accepted: 10/15/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE implant placement Essure, sterilization procedure for women, were performed under hypnosedation (HYP) and compared to the operative anxiety and analgesia of 12 patients operated-on under general anesthesia (GA). STUDY DESIGN prospective and comparative group study. PATIENTS AND METHODS two groups of twelve patients were matched and compared based on the choice of anesthetic technique: hypnotics (HYP) with possible additional sedation by propofol and remifentanil or GA involving propofol, sevoflurane and remifentanil. The assessment of anxiety and pain based on a visual analogy scale (0-10) and use of analgesics were studied in the recovery room and at discharge of hospital. The statistical analysis relies on nonparametric tests for paired data (Wilcoxon test). RESULTS all patients were operated. The two groups are statistically comparable. The preoperative anxiety before premedication is lower in the HYP group (p<0.05). No conversion to general anaesthesia is necessary in the HYP group, but five patients were using sedatives drugs but doses are very low compared to general anaesthesia. The analgesic consumption was equivalent in both groups. CONCLUSION we conclude that hypnosedation is a valuable alternative to traditional anesthetic techniques for ambulatory Essure implant. The use of hypnotic tool is an interesting alternative for the management of patients during invasive medical procedures or surgical, providing psychological benefits to the patient.
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Portaluppi F, Smolensky MH, Touitou Y. ETHICS AND METHODS FOR BIOLOGICAL RHYTHM RESEARCH ON ANIMALS AND HUMAN BEINGS. Chronobiol Int 2010; 27:1911-29. [DOI: 10.3109/07420528.2010.516381] [Citation(s) in RCA: 973] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Portaluppi F, Smolensky MH. PERSPECTIVES ON THE CHRONOTHERAPY OF HYPERTENSION BASED ON THE RESULTS OF THE MAPEC STUDY. Chronobiol Int 2010; 27:1652-67. [DOI: 10.3109/07420528.2010.510788] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Francesco Portaluppi
- Hypertension Center, Department of Medicine, University Hospital “S. Anna” of Ferrara, Ferrara, Italy
| | - Michael H. Smolensky
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
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Dispersyn G, Chassard D, Pain L. [Biological rhythms for anaesthesia and intensive care]. ACTA ACUST UNITED AC 2010; 29:470-7. [PMID: 20598847 DOI: 10.1016/j.annfar.2010.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 05/14/2010] [Indexed: 12/31/2022]
Abstract
Knowledge of biological rhythms has led to better understanding of the time-of-day dependent effects of anaesthetic drugs. These chronopharmacological effects are currently explained by the biological rhythms modulating the pharmacokinetic, toxic and pharmacodynamic parameters of these substances. Such effect has been described for general anesthetics, local anaesthetics, analgesics as well as for antibiotics. But recent data also highlight that general anaesthetics, probably part of their brain effects, also alter the regulation of biological rhythms, including the sleep-wake or the endogenous circadian temperature rhythms. This desynchronization of biological rhythms can led to disturbance of the circadian secretion of many substances, including hormones. Finally, biological rhythms have been also described with regard to physiology of pain and cardiovascular physiopathology. The concept of biological rhythm should be present in mind not only for the clinical management of patients but also for setting studies in the field of anaesthesia, pain and intensive care.
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Affiliation(s)
- G Dispersyn
- Inserm U, CHRU de Strasbourg, université Louis-Pasteur, France
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41
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Melatonin and postoperative delirium: a possible link? Can J Anaesth 2010; 57:794-5. [PMID: 20524101 DOI: 10.1007/s12630-010-9340-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022] Open
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Shi Q, Guo L, Patterson TA, Dial S, Li Q, Sadovova N, Zhang X, Hanig JP, Paule MG, Slikker W, Wang C. Gene expression profiling in the developing rat brain exposed to ketamine. Neuroscience 2010; 166:852-63. [PMID: 20080153 DOI: 10.1016/j.neuroscience.2010.01.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 01/04/2010] [Accepted: 01/05/2010] [Indexed: 12/31/2022]
Abstract
Ketamine, a non-competitive N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with accelerated neuronal apoptosis in the developing rodent brain. In this study, postnatal day (PND) 7 rats were treated with 20 mg/kg ketamine or saline in six successive doses (s.c.) at 2-h intervals. Brain frontal cortical areas were collected 6 h after the last dose and RNA isolated and hybridized to Illumina Rat Ref-12 Expression BeadChips containing 22,226 probes. Many of the differentially expressed genes were associated with cell death or differentiation and receptor activity. Ingenuity Pathway Analysis software identified perturbations in NMDA-type glutamate, GABA and dopamine receptor signaling. Quantitative polymerase chain reaction (Q-PCR) confirmed that NMDA receptor subunits were significantly up-regulated. Up-regulation of NMDA receptor mRNA signaling was further confirmed by in situ hybridization. These observations support our working hypothesis that prolonged ketamine exposure produces up-regulation of NMDA receptors and subsequent over-stimulation of the glutamatergic system by endogenous glutamate, triggering enhanced apoptosis in developing neurons.
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Affiliation(s)
- Q Shi
- Division of Systems Toxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, USA
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Do Sleep Disorders have an Impact on Outcome in ICU Patients? Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Portaluppi F, Cortelli P, Buonaura GC, Smolensky MH, Fabbian F. Do restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) play a role in nocturnal hypertension and increased cardiovascular risk of renally impaired patients? Chronobiol Int 2009; 26:1206-21. [PMID: 19731113 DOI: 10.3109/07420520903245276] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypertension can cause or promote renal failure and is related to cardiovascular mortality, the major cause of death in patients with renal impairment. Changes in the circadian BP pattern, particularly the blunting or reversal of the nocturnal decline in BP, are common in chronic renal failure. These changes in turn are among the major determinants of left ventricular hypertrophy. Using a chronobiological approach, it is possible to obtain better insight into the reciprocal relationship between hypertension, renal disease, and increased cardiovascular risk of renal patients. Disruption of the normal circadian rhythm of rest/activity may be hypothesized to underlie the high cardiovascular morbidity and mortality of such patients. Epidemiological studies reveal that hemodialysis patients experience poor subjective sleep quality and insomnia and, in comparison to healthy persons, are more likely to show shorter sleep duration and lower sleep efficiency. Sleep apnea may be present and is usually investigated in these patients; however, the prevalence of restless legs syndrome (RLS), which is high in dialysis patients and which has been associated with increased risk for cardiovascular disease in the general population, could also play a role in the pathogenesis of sleep-time hypertension in renal patients. Careful assessment of sleep quality, in particular, diagnostic screening for RLS and periodic limb movements (PLM) in renal patients, is highly recommended. In renal failure, attention to sleep quality and related perturbations of the sleep/wake cycle may help prevent the occurrence and progression of cardiovascular disease.
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Affiliation(s)
- Francesco Portaluppi
- Hypertension Center and Clinica Medica, University Hospital S. Anna of Ferrara, Ferrara, Italy.
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Pain L, Laalou FZ. [Postanesthesia cognitive dysfunction]. Presse Med 2009; 38:1597-606. [PMID: 19786338 DOI: 10.1016/j.lpm.2009.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/30/2009] [Accepted: 05/04/2009] [Indexed: 11/27/2022] Open
Abstract
The cognitive dysfunctions observed in patients after anesthesia are due not only to the effects of but also to the surgery, the disease requiring surgery, and post-operative treatment. Initial cognitive recovery from anesthetic agents is usually fast, from several hours to several days, but can be delayed by postoperative treatment (analgesia, for example) that have deleterious cognitive effects. During the initial period after surgery, acute impairment of cognitive functions is seen in some patients at risk (major surgery, aged patients, brain sensitivity, or sepsis), specifically transitory (1-3 days in most cases) postoperative delirium. This delirium or confusion requires follow-up at 3 months to check cognitive functions, especially in aged patients. Cohort studies show that cognitive impairment can be objectively identified at one week after surgery with general anesthesia in around 40% of patients, regardless of age. This risk is reduced slightly by the use of loco-regional anesthesia. Cognitive dysfunction is still observed at 3 months after surgery in about 10-15% of patients older than 60 years and in about 6% of younger patients. In patients with a pre-existing cerebral disease with cognitive symptoms, the incidence of long-lasting additional cognitive impairment remains unknown. The mechanisms of this long-term cognitive dysfunction remain to be elucidated.
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Affiliation(s)
- Laure Pain
- Groupe de recherches et d'études sur les répercussions cognitivo-affectives de l'anesthésie, Inserm U666 ; Pôle anesthésie réanimation, CHU de Strasbourg, Faculté de médecine, F-67000 Strasbourg, France.
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Dispersyn G, Sage D, Challet E, Pain L, Touitou Y. Plasma Corticosterone in Rats Is Specifically Increased at Recovery from Propofol Anesthesia without Concomitant Rise of Plasma ACTH. Chronobiol Int 2009; 26:697-708. [DOI: 10.1080/07420520902926033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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