Journal of Clinical PracticeJournal of Clinical PracticeКлиническая практика2220-30952618-8627Eco-Vector63031010.17816/clinpract630310ReviewsНаучные обзорыReview ArticleСontribution of circadian rhythms to the development of neurological disorders after prolonged anesthesiaВклад циркадных ритмов в развитие неврологических нарушений после длительного анестезиологического обеспеченияhttps://orcid.org/0009-0002-7289-45873824-0682MazurovNikita A.МазуровНикита Александрович
Russian Federation
nikita_banzay@mail.ruhttps://orcid.org/0000-0002-7598-77573162-0770KicherovaOksana A.КичероваОксана Альбертовна
Russian Federation

MD, PhD, Associate Professor

д-р мед. наук, доцент

pan1912@mail.ruhttps://orcid.org/0000-0002-6294-17767776-4134VerbakhTatyana E.ВербахТатьяна Эдуардовна
Russian Federation

MD, PhD

канд. мед. наук

shtork@yandex.ruhttps://orcid.org/0000-0003-4313-08361703-2302ReichertLyudmila I.РейхертЛюдмила Ивановна
Russian Federation

MD, PhD, Professor

д-р мед. наук, профессор

lir0806@gmail.comhttps://orcid.org/0000-0002-8486-496X2748-9442DoyanYulia I.ДоянЮлия Ивановна
Russian Federation

MD, PhD

канд. мед. наук

yul-gol25@yandex.ruhttps://orcid.org/0009-0002-1304-2202SaltanovaValentina A.СалтановаВалентина Анатольевна
Russian Federation
valentinaslt72@gmail.comTyumen State Medical UniversityТюменский государственный медицинский университет220620241507202415259641304202410052024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://clinpractice.ru/clinpractice/article/view/630310

Despite the improvement of pre-, intra- and postoperative care methods, the problem of the development of postoperative neurological complications following prolonged anesthesia remains. A mechanism of occurrence of these complications may be circadian rhythm disorders. This article presents a review of the literature data on the prevalence, pathophysiological mechanisms, and risk factors of postoperative autonomic and circadian disorders. Notably, circadian rhythm disorders in surgical patients are observed at several levels: disruption of the sleep and wakefulness cycle, decreased melatonin secretion, instability of cortisol levels and body temperature, and changes in the vegetative balance towards sympathetic regulation. These disorders contribute to the development of postoperative pain and cognitive and anxiety-depressive disorders, hinder effective rehabilitation, and may be associated with postoperative mortality.

Несмотря на совершенствование методов до-, интра- и послеоперационного ухода, сохраняется проблема послеоперационных неврологических осложнений после длительного анестезиологического пособия. Одним из механизмов возникновения указанных осложнений могут быть нарушения циркадного ритма. Авторами представлен обзор литературных данных о распространённости, патофизиологических механизмах и факторах риска послеоперационных вегетативных и циркадных нарушений. Установлено, что нарушения циркадного ритма у хирургических больных наблюдаются на нескольких уровнях: нарушение цикла сна и бодрствования, снижение секреции мелатонина, нестабильность уровня кортизола и температуры тела, а также изменение вегетативного баланса в сторону симпатической регуляции. Указанные нарушения способствуют развитию постоперационной боли, неврологических, когнитивных и тревожно-депрессивных нарушений, препятствуют эффективной реабилитации и могут быть связаны с послеоперационной смертностью.

postoperative neurological disorderscircadian rhythm disordersautonomic dysfunctionsleep disordersпостоперационные неврологические нарушениянарушения циркадного ритмавегетативная дисфункциянарушения снаSmolensky MH, Portaluppi F, Manfredini R, et al. Diurnal and twenty-four hour patterning of human diseases: Cardiac, vascular, and respir-atory diseases, conditions, and syndromes. Sleep Med Rev. 2015;(21):3–11. doi: 10.1016/j.smrv.2014.07.001Gögenur I. Postoperative circadian disturbances. Danish Medical Bulletin. 2010;57(12):B4205.Зотов П.Б., Аксельров М.А., Аксельров П.М., и др. «Качество жизни» в клинической практике. Тюмень, 2022. 352 с. [Zotov PB, Axelrov MA, Axelrov PM, et al. ‘Quality of life’ in clinical practice. Tyumen; 2022. 352 р. (In Russ).] EDN: QXVIHNРейхерт Л.И., Кичерова О.А., Ахметьянов М.А. Связанное со здоровьем качество жизни в неврологической практике // Академический журнал Западной Сибири. 2022. Т. 18, № 3. С. 25–34. [Reichert LI, Kicherova OA, Akhmetyanov MA. Health-related quality of life in neurological practice. Academic Journal West Siberia. 2022;18(3):25–34]. EDN: TYISHP doi: 10.32878/sibir.22-18-03(96)-25-34Aarts MA, Rotstein OD, Pearsall EA, et al. Postoperative ERAS interventions have the greatest impact on optimal recovery: experience with implementation of ERAS across multiple hospitals. Ann Surg. 2018;267(6):992–997. doi: 10.1097/SLA.0000000000002632Hansen MV. Chronobiology, cognitive function and depressive symptoms in surgical patients. Danish Med J. 2014;61(9):B4914.Kurbegovic S, Andersen J, Krenk L, Kehlet H. Delirium in fast-track colonic surgery. Langenbecks Arch Surg. 2015;400(4): 513–516. EDN: QUYWHW doi: 10.1007/s00423-015-1297-8Kvaslerud T, Hansen MV, Rosenberg J, Gögenur I. Circadian aspects of post-operative morbidity and mortality: Circadian aspects of post-operative morbidity and mortality. Acta Anaesthesiol Scand. 2010;54:1157–1163. doi: 10.1111/j.1399-6576.2010.02296.xGögenur I, Wildschiøtz G, Rosenberg J. Circadian distribution of sleep phases after major abdominal surgery. Brit J Anaesthesia. 2008;100(1):45–49. EDN: IMLCBZ doi: 10.1093/bja/aem340Gögenur I, Rosenberg-Adamsen S, Kiil C, et al. Laparoscopic cholecystectomy causes less sleep disturbancethan open abdominal surgery. Surg Endoscopy. 2001;15(12):1452–1455. EDN: ASTOYJ doi: 10.1007/s004640090086Alkire MT, Hudetz AG, Tononi G. Consciousness and anesthesia. Science. 2008;322(5903):876–880. doi: 10.1126/science.1149213Jiang-Xie LF, Yin L, Zhao S, et al. A common neuroendocrine substrate for diverse general anesthetics and sleep. Neuron. 2019;102(5):1053–1065. doi: 10.1016/j.neuron.2019.03.033Fukuda S, Yasuda A, Lu Z, et al. [Effect sites of anesthetics in the central nervous system network-looking into the mechanisms for natural sleep and anesthesia. (In Japanese)]. Masui. 2011;60(5):544–558. EDN: OLMOTTKushikata T, Sawada M, Niwa H, et al. Ketamine and propofol have opposite effects on postanesthetic sleep architecture in rats: Relevance to the endogenous sleep-wakefulness substances orexin and melanin-concentrating hormone. J Anesth. 2016;30(3):437–443. EDN: RDHRSG doi: 10.1007/s00540-016-2161-xGuo XY, Luo AL, Ren HZ, et al. [Perioperative melatonin secretion rhyme in patients undergoing coronary artery bypass grafting surgery. (In Chinese)]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003;25(5):594–598.Pick J, Chen Y, Moore JT, et al. Rapid eye movement sleep debt accrues in mice exposed to volatile anesthetics. Anesthesiology. 2011;115(4):702–712. doi: 10.1097/ALN.0b013e31822ddd72Wren-Dail MA, Dauchy RT, Blask DE, et al. Effect of isoflurane anesthesia on circadian metabolism and physiology in rats. Comp Med. 2017;67(2):138–146.Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med. 2007;3(1):33–36.Tian JX, Yin C, Chu SS, et al. Murine clock gene expression in the suprachiasmatic nuclei and peripheral blood mononuclear cells during the daily sleep-wake rhythm and after isoflurane anesthesia. Sleep Biolog Rhythms. 2015;13(4):357–365. doi: 10.1111/sbr.12126Poole L, Kidd T, Leigh E, et al. Preoperative sleep complaints are associated with poor physical recovery in the months following cardiac surgery. Ann Behav Med. 2014;47(3):347–357. doi: 10.1007/s12160-013-9557-8Wang PK, Cao J, Wang H, et al. Short-term sleep disturbance-induced stress does not affect basal pain perception, but does delay postsurgical pain recovery. J Pain. 2015;16(11):1186–1199. doi: 10.1016/j.jpain.2015.07.006Li Q, Zhu ZY, Lu J, et al. Sleep deprivation of rats increases postsurgical expression and activity of L-type calcium channel in the dorsal root ganglion and slows recovery from postsurgical pain. Acta Neuropathol Commun. 2019;7(1):217. EDN: ZFJJBQ doi: 10.1186/s40478-019-0868-2Rhon DI, Greenlee TA, Marchant BG, et al. Comorbidities in the first 2 years after arthroscopic hip surgery: Substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions. Brit J Sports Med. 2019;53(9):547–553. doi: 10.1136/bjsports-2018-099294Konttinen H, Sjöholm K, Jacobson P, et al. Prediction of suicide and nonfatal self-harm after bariatric surgery: A risk score based on sociodemographic factors, lifestyle behavior, and mental health. A nonrandomized controlled trial. Ann Surg. 2021;274(2):339–345. doi: 10.1097/SLA.0000000000003742Fadayomi AB, Ibala R, Bilotta F, et al. A systematic review and meta-analysis examining the impact of sleep disturbance on postoperative delirium. Crit Care Med. 2018;46(12):1204–1212. doi: 10.1097/CCM.0000000000003400Ni P, Dong H, Zhou Q, et al. Preoperative sleep disturbance exaggerates surgery-induced neuroinflammation and neuronal damage in aged mice. Mediators Inflamm. 2019;2019:8301725. doi: 10.1155/2019/8301725Gögenur I, Middleton B, Burgdorf S, et al. Impact of sleep and circadian disturbances in urinary 6-sulphatoxymelatonin levels, on cognitive function after major surgery. Pineal Res. 2007;43(2):179–184. doi: 10.1111/j.1600-079X.2007.00460.xCronin AJ, Keifer JC, Davies MF, et al. Melatonin secretion after surgery. Lancet. 2000;356(9237):1244–1245. EDN: EERXXP doi: 10.1016/S0140-6736(00)02795-1Gögenur I, Ocak U, Altunpinar O, et al. Disturbances in melatonin, cortisol and core body temperature rhythms after major surgery. World J Surg. 2007;31(2):290–298. EDN: LXDQLA doi: 10.1007/s00268-006-0256-5Shenshen Y, Minshu W, Qing Y, et al. The effect of cataract surgery on salivary melatonin and sleep quality in aging people. Chronobiol Int. 2016;33(8):1064–1072. doi: 10.1080/07420528.2016.1197234Yoshitaka S, Egi M, Morimatsu H, et al. Perioperative plasma melatonin concentration in postoperative critically ill patients: Its association with delirium. J Crit Care. 2013;28(3):236–242.Song Y, Liu Y, Yuan Y, et al. 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. EBioMed. 2021;(70):103490. doi: 10.1016/j.ebiom.2021.103490Ibrahim MG, Bellomo R, Hart GK, et al. A double-blind placebo-controlled randomised pilot study of nocturnal melatonin in tracheostomised patients. Crit Care Resusc. 2006;8(3):187–191.Khoo B, Boshier PR, Freethy A, et al. Redefining the stress cortisol response to surgery. Clin Endocrinol (Oxf). 2017;87(5):451–458. doi: 10.1111/cen.13439Filipovic M, Jeger RV, Girard T, et al. Predictors of long-term mortality and cardiac events in patients with known or suspected coronary artery disease who survive major non-cardiac surgery. Anaesthesia. 2005;60(1):5–11. doi: 10.1111/j.1365-2044.2004.03996.xBuccelletti E, Gilardi E, Scaini E, et al. Heart rate variability and myocardial infarction: Systematic literature review and metanalysis. Eur Rev Med Pharmacol Sci. 2009;13(4):299–307.Hansen MV, Rosenberg J, Gögenur I. Lack of circadian variation and reduction of heart rate variability in women with breast cancer undergoing lumpectomy: A descriptive study. Breast Cancer Res Treat. 2013;140(2):317–322. doi: 10.1007/s10549-013-2631-xZhang J, Tu W, Dai J, et al. Dysfunction of pre- and post-operative cardiac autonomic nervous system in elderly patients with diabetes mellitus. Arch Gerontol Geriatrics. 2011;53(3): 334–337. doi: 10.1016/j.archger.2010.12.013Hardy PJ, Tavano A, Jacquet SV, et al. The impact of orthostatic intolerance on early ambulation following abdominal surgery in an enhanced recovery programme. Acta Anaesthesiol Scand. 2022;66(4):454–462. EDN: GILIKS doi: 10.1111/aas.14034Mizota T, Iwata Y, Daijo H, et al. Orthostatic intolerance during early mobilization following video-assisted thoracic surgery. J Anesthesia. 2013;27(6):895–900. EDN: EJFSDP doi: 10.1007/s00540-013-1634-4Gobezie NZ, Endalew NS, Tawuye HY, Aytolign HA. Prevalence and associated factors of postoperative orthostatic intolerance at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2022: Cross sectional study. BMC Surg. 2023;23(1):108. EDN: SEUGUG doi: 10.1186/s12893-023-02015-5Hanada M, Tawara Y, Miyazaki T, et al. Incidence of orthostatic hypotension and cardiovascular response to postoperative early mobilization in patients undergoing cardiothoracic and abdominal surgery. BMC Surg. 2017;17(1):111. EDN: SRGRXC doi: 10.1186/s12893-017-0314-yEriksen JR, Munk-Madsen P, Kehlet H, Gögenur I. Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection. Acta Anaesthesiol Scand. 2019;63(2):171–177. doi: 10.1111/aas.13238De Campos TF, Vertzyas N, Wolden M, et al. Orthostatic intolerance-type events following hip and knee arthroplasty: A systematic review and meta-analysis. J Bone Joint Surg Am. 2023;105(3):239–249. doi: 10.2106/JBJS.22.00600Ho CN, Fu PH, Hung KC, et al. Prediction of early postoperative pain using sleep quality and heart rate variability. Pain Pract. 2024;24(1):82–90. EDN: FMBRYJ doi: 10.1111/papr.13288Hristovska AM, Uldall-Hansen B, Mehlsen J, et al. Orthostatic intolerance after acute mild hypovolemia: Incidence, pathophysiologic hemodynamics, and heart-rate variability analysis-A prospective observational cohort study. Can J Anaesth. 2023;70(10):1587–1599. doi: 10.1007/s12630-023-02556-6Jans Ø, Brinth L, Kehlet H, Mehlsen J. Decreased heart rate variability responses during early postoperative mobilization: An observational study. BMC Anesth. 2015;(15):120. EDN: XQGHHK doi: 10.1186/s12871-015-0099-4Bundgaard-Nielsen M, Jans Ø, Müller RG, et al. Does goal-directed fluid therapy affect postoperative orthostatic intolerance? A randomized trial. Anesthesiology. 2013;119(4): 813–823. doi: 10.1097/ALN.0b013e31829ce4eaChen A, Ashburn MA. Cardiac effects of opioid therapy. Pain Med. 2015;16(Suppl. 1):27–31. doi: 10.1111/pme.12915Iwata Y, Mizota Y, Mizota T, et al. Postoperative continuous intravenous infusion of fentanyl is associated with the development of orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery. J Anesth. 2012;26(4):503–508. EDN: VCQCQU doi: 10.1007/s00540-012-1391-9Huston JM, Tracey KJ. The pulse of inflammation: Heart rate variability, the cholinergic anti-inflammatory pathway and implications for therapy. J Intern Med. 2011;269(1):45–53. doi: 10.1111/j.1365-2796.2010.02321.x