General Anesthesia for Surgery Influences Melatonin and Cortisol Levels

Abstract

The purpose of this study was to investigate the effect of general anesthesia and surgery on melatonin production, and to assess the relationship between melatonin secretion and cortisol levels. Twenty (9 males and 11 females) consecutive otherwise healthy patients aged 27 to 52 years were included in this study. The patients underwent laparoscopic cholecystectomy or laparoscopic hernioplasty. All patients had general anesthesia with the same anesthetic drugs. Serum cortisol levels were measured at several time periods. Urine collections for melatonin were performed from 18:00 to 7:00 the day prior to surgery, on the operation day, and on the first postoperative day. Baseline melatonin metabolites were measured the night prior to surgery, and the level was found to be 1979 +/- 1.76 ng. The value decreased to 1802 +/- 1.82 ng (NS) on the night of surgery, and it became a significantly higher, reaching 2981 +/- 1.55 ng the night after surgery (p = .003). The baseline daytime cortisol level was significantly lower than the baseline night cortisol level (6.87 +/- 1.51 microg/dl, 14.89 +/- 1.66 micrograms/dl, respectively, p < 0.0001). Surgery induced a significant increase in both day and night cortisol levels. Daytime cortisol levels increased from 6.89 +/- 1.51 microg/dl to 16.90 +/- 1.27microg/dl (p < 0.0001), whereas right levels increased from 14.89 +/- 1.66 microg/dl to 29.20 +/- 1.24 microg/ dl (p <0.0001). The morning after surgery, cortisol levels decreased to 10.16 +/- 1.40 microg/dl, lower than the value obtained on the day of surgery (p < 0.0001). As was true of melatonin, cortisol levels did not reach the pre operative level (p < 0.005). The finding of the current study is that melatonin and cortisol levels show an inverse correlation after surgery.

Effect of Different Doses of Dexmedetomidine on Stress Response and Emergence Agitation after Laparoscopic Cholecystectomy: Randomized Controlled Double-Blind Study

“…Hemodynamic changes are usually unpredictable [27]. Cortisol level is widely used as the marker of surgical stress response [28]. A dose-dependent decrease in heart rate and arterial blood pressure occurred with dexmedetomidine, and decrease of sympathetic nervous activity was observed through the recorded levels of norepinephrine in plasma [29].…”

The effect of MELatOnin on Depression, anxietY, cognitive function and sleep disturbances in patients with breast cancer. The MELODY trial: protocol for a randomised, placebo-controlled, double-blinded trial

“…After surgery, melatonin secretion has shown to be acutely disturbed37 with a delay of secretion and reduced amplitude 38 39. Various lines of evidence show that depressed patients exhibit disturbances in both the amplitude and the shape of the melatonin secretion rhythm, with some studies showing a low nocturnal melatonin secretion and others showing an increase in secretion 35.…”

General Anesthetics Effects on Circadian Temporal Structure: An Update

“…Because anesthesia is not uncoupled from surgery, it is difficult to separate the effects of general anesthetics from the effects related to, for example, pain, surgical stress, tissue injury, post-operatively administered medications, and hospital stay conditions (Paul & Lemmer, 2007). Though some studies (e.g., Karkela et al, 2002;Ram et al, 2005) suggest that general anesthesia could result in a desynchronization of the circadian time structure, none of these studies documented this aspect. Internal desynchronization is defined as a state in which the circadian period (t) of a set of rhythms differs from 24 h (Reinberg et al, 2007), resulting in an alteration of the normal phase relationships between rhythms, which in turn may give rise to a number of atypical clinical signs, such as fatigue, sleep disorders, and mood alteration.…”

“…Indeed, it was shown by Turkistani et al (2007) that an oral (3 mg) dose of melatonin, as a pre-medication, reduced the dose of propofol required to induce anesthesia, without prolongation of the post-operative recovery room stay. Two studies (Karkela et al, 2002;Ram et al, 2005) using thiopentalisoflurane-fentanyl for morning orthopaedic and laparoscopy surgeries, respectively, showed that serum and salivary melatonin levels decreased the first night after anesthesia and did not regain the basal secretion level until 48 h or longer. Cronin et al (2000) also demonstrated that general anesthesia by inhalation (anesthetic unspecified) conducted in conjunction with a gynecology surgical procedure decreased nocturnal melatonin concentration the night following intervention compared to the second and third post-operative nights, with the decrease amounting to 350% between the first and third nights; melatonin secretion returned to basal values only after the third night.…”