Effects of circadian rhythm on Narcotrend index and target-controlled infusion concentration of propofol anesthesia

Jiang-Hua Shen, Min Ye, Qian Chen, Yan Chen, Hai-Lin Zhao, Ameena Khan, Bin Yi, Jiao-Lin Ning, Kai-Zhi Lu, Jian-Teng Gu, Jiang-Hua Shen, Min Ye, Qian Chen, Yan Chen, Hai-Lin Zhao, Ameena Khan, Bin Yi, Jiao-Lin Ning, Kai-Zhi Lu, Jian-Teng Gu

Abstract

Background: The effects of circadian rhythms on drug metabolism and efficacy are being increasingly recognized. However, the extent to which they affect general anesthesia remains unclear. This study aims to investigate the effects of circadian rhythms on anesthetic depth and the concentrations of propofol target-controlled infusion (TCI).

Methods: Sixty patients undergoing laparoscopic surgeries were sequentially assigned to four groups. Group ND (n = 15): Propofol TCI with Narcotrend monitor during the day (8:00-18:00), Group NN (n = 15): Propofol TCI with Narcotrend monitor during the night (22:00-5:00), Group CLTD (n = 15): Propofol closed-loop TCI guided by bispectral index (BIS) during the day (8:00-18:00), Group CLTN (n = 15): Propofol closed-loop TCI guided by BIS during the night (22:00-5:00). The Narcotrend index, mean arterial pressure (MAP) and heart rate (HR) were compared between group ND and NN at 7 time points, from 5 min before induction to the end of operation. The propofol TCI concentrations, MAP and HR were compared between group CLTD and CLTN at 7 time points, from 5 min after induction to the end of operation.

Results: The Narcotrend index, MAP, and HR in group NN were lower than those in group ND from the beginning of mechanical ventilation to the end of operation (p < 0.05). The propofol TCI concentrations in group CLTN were lower than those in group CLTD from the beginning of operation to the end of operation (p < 0.05).

Conclusion: Circadian rhythms have a significant effect on the depth of anesthesia and drug infusion concentrations during propofol TCI. When using general anesthesia during night surgery, the propofol infusion concentration should be appropriately reduced compared to surgery during the day.

Trial registration: The present study was registered on the ClinicalTrials.gov website ( NCT02440269 ) and approved by the Medical Ethics Committee of Southwest Hospital of Third Military Medical University (ethics lot number: 2016 Research No. 93). All patients provided informed written consent to participate in the study.

Keywords: Circadian rhythm; Depth of anesthesia; Propofol; Target controlled infusion.

Conflict of interest statement

None.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Variations of Narcotrend index in group ND and NN. Note: Data are presented as mean ± standard deviation. *, compared with the Narcotrend index in the group NN at each time point, p < 0.05. Abbreviations: ND, Narcotrend monitor during the day (8:00–18:00), NN: Narcotrend monitor during the night (22:00–5:00). T1 (5 min before induction), T2 (beginning of mechanical ventilation), T3 (mechanical ventilation for 5 min), T4 (beginning of operation), T5 (operation for 10 min), T6 (operation for 30 min), T7 (end of operation)
Fig. 3
Fig. 3
Variations of Targeted concentrations of propofol in group CLTD and CLTN. Note: Data are presented as mean ± standard deviation. *, compared with the concentration of propofol in the group CLTN at each time point, p < 0.05. Abbreviations: CLT, Closed-loop TCI. CLTD, Closed-loop TCI during the day (8:00–18:00). CLTN, Closed-loop TCI during the night (22:00–5:00). T1 (5 min after induction), T2 (beginning of ventilation), T3 (mechanical ventilation for 5 min), and T4 (beginning of operation), T5 (operation for 10 min), T6 (operation for 30 min) and T7 (end of operation)

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