Circadian Rhythms in Anesthesia and Critical Care Medicine

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 last 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 impact patient outcomes. Intriguingly, sedatives, anesthetics, and the ICU 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.

24-Hour protein, arginine and citrulline metabolism in fed critically ill children – A stable isotope tracer study

“…Circadian rhythms are regulated by peripheral and central clock genes (27). Disruption of clock genes and circadian de-synchrony have been associated with metabolic pathologies, increased risk for morbidities, (obesity, diabetes) (27), and may influence sepsis (28). The absence or disruption of circadian rhythms in critically ill patients is possibly unfavorable and a potential therapeutic target (28).…”

Editorial (Thematic Issue: Health Impact and Management of a Disrupted Circadian Rhythm and Sleep in Critical Illnesses)

“…during sepsis, heart ischemia or lung disease), the need to monitor light or to treat disrupted circadian rhythms has not been introduced into clinical practice yet. During the last 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 (2, 4, 5). Interestingly, the ICU environment in particular has been shown to disrupt the circadian system of patients (2).…”

“…During the last 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 (2, 4, 5). Interestingly, the ICU environment in particular has been shown to disrupt the circadian system of patients (2). Newly acquired knowledge of circadian rhythms could now lead to changes in clinical practice and new therapeutic concepts for critical illness and associated diseases and complications.…”

“…Future analysis of different light conditions in different settings seems mandatory to understand the impact on health and well-being. Future research will hopefully guide us how to use light a therapy (2, 4, 5). …”

“…However, more important is that disruption of a circadian rhythm function leads directly to disease development and might be an important factor for disease severity in critical ill patients (2, 5). Even though we have realized that our environment – in the hospital or at home - has a significant impact on the integrity of circadian rhythms and sleep we still have not established a monitoring system or a potent therapy to restore a dysfunctional circadian system.…”