Changes in postoperative night bispectral index of patients undergoing thoracic surgery with different types of anaesthesia management: a randomized controlled trial

Abstract

This study hypothesized that different types of anaesthesia management would result in similar postoperative sleep quality. In this prospective single-blind investigation, 219 patients undergoing elective thoracic surgery were randomized into three arms: general anaesthesia, as the control group (group C); general anaesthesia combined with thoracic epidural anaesthesia (TEA) (group E); and general anaesthesia combined with infusion of 1 μg/kg dexmedetomidine (group D). Plasma samples were obtained to measure the amine and inflammatory cytokine concentrations. All patients underwent assessment with the bispectral index (BIS) for sleep quality and the visual analogue scale (VAS) for pain. The primary outcomes were inflammatory cytokine [interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α)] secretion and postoperative sleep quality on the first and second postoperative nights. The secondary outcomes were amine (adrenaline and noradrenaline) secretion during the surgical period and haemodynamic stability. The postoperative BIS area under the curve was significantly lower in group E (75.7%) than in group C (87.3%) or group D (86.5%). Patients in group E had the highest BIS of sleep efficiency index (29.2%, P < 0.05) and the lowest VAS scores (3.5, P < 0.05). Group E had lower IL-6 levels than the other two groups 24 h after surgery (P < 0.05). Patients given TEA may show reduced sleep disturbances on the first night after surgery, perhaps due to better pain management and inhibition of IL-6 release.

RETRACTED ARTICLE: Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels in patients with open midline incisions undergoing transabdominal gynecological surgery: a randomized-controlled trial

“…Increased IL-6 levels may be associated with alterations in sleep in the context of pathological or other conditions [ 22 ]. In our previous study, we found that patients receiving epidural analgesia may have preserved sleep quality on the first night after surgery due to better pain management and inhibition of increasing IL-6 levels [ 11 ]. The upregulation of IL-6 at central sites is an important component of the surgery-induced inflammatory response in patients and may influence postoperative sleep [ 23 ].…”

“…The peripheral inflammatory response to surgery may influence patient outcomes, such as postoperative sleep, and we have published two clinical trials on this topic using the bispectral index (BIS) to monitor sleep [ 11 , 12 ]. Postoperative sleep disturbances after surgery can be caused by factors such as the anesthesia used, pain and sympathetic activation and psychological responses [ 13 ].…”

0934 Evaluating the Effects of General Anesthesia on Sleep in Children Undergoing Elective Surgery

“…Those who received sevoflurane anesthesia combined with an epidural during surgery experienced better postoperative sleep quality compared to patients in the other groups. Nonetheless, the investigators acknowledged that more valid measures, such as an EEG, should be used to provide an accurate assessment for sleep quality (Tan et al, 2016). Overall, these findings suggest that the quality of postoperative sleep may differ depending on the type of anesthesia that is administered.…”

“…Further evidence shows that continuous administration of a specific agent, like dexmedetomidine, can improve sleep architecture by reducing NREM-1 sleep, increasing NREM-2 sleep and reducing sleep fragmentation (Alexopoulou et al, 2014;Wu et al, 2016). These findings suggest that certain drugs may be used in combination with general anesthesia to improve sleep quality following surgery, but additional research using validated measures for sleep would be useful (Tan et al, 2016). There have been a few studies that have shown poor sleep quality among children following surgery (Kain et al, 2002;Steinmetz et al, 2007).…”

<p>Postoperative 24-h Acute Sleep Deprivation Improves Learning and Memory Through Inhibition of Tau Phosphorylation in the Hippocampal Neurons of Splenectomized Rats</p>

“…The results of our clinical trials suggest that IL-6 causes postoperative sleep disturbances. 11,12 Forkhead box (FOX) family proteins are involved in a wide range of crucial cellular processes, including stress resistance, metabolism, cell cycle arrest, ageing and apoptosis. 13 Foxq1 was first found to modulate hair follicle development in mammals, 13 and FOXQ1 remarkably inhibits replicative senescence through suppressing IL-6 expression.…”