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Disturbances in Melatonin, Cortisol and Core Body Temperature Rhythms after Major Surgery

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Abstract

Background

It has been suggested that circadian rhythm disturbances are present after major surgery and that this may play a role in the development of postoperative sleep disturbances, fatigue, cognitive dysfunction and cardiovascular morbidity. The objective of this study was to examine the profile of melatonin, cortisol and core body temperature rhythms before and after major surgery.

Methods

Blood samples (melatonin and cortisol) and core body temperature readings were collected every hour in the 24-h period prior to surgery and the 48 h after surgery from 11 patients undergoing major abdominal surgery. All patients had private rooms. Light exposure was controlled and monitored. Phase markers [50% dim light melatonin onset (DLMO 50%) and offset (DLMOff 50%), cortisol and core body temperature acrophase] for the three circadian rhythm profiles were calculated before and after surgery. The correlation between the melatonin rhythm and time of surgery, duration of surgery and opioid use was examined.

Results

A median delay in the onset of melatonin was seen on the first postoperative day [median DLMO 50% 22:46 hours (range: 21:15–01:08 hours) on the preoperative day compared with 23:54 hours (range: 19:09–02:46 hours) on the first postoperative day; P ≤ 0.05] . A significant positive correlation existed between the duration of surgery and the time of melatonin onset (r = 0.67, P ≤ 0.05) . There was a significantly reduced basal secretion of melatonin immediately after surgery, with a subsequent significant increase in maximum melatonin values on the second postoperative night. A median delay of up to 4 h was seen in the timing of the peak of the temperature rhythm on the second postoperative day. Both cortisol secretion and core body temperature were increased after surgery and did not return to preoperative values in the 48 h of the postoperative study period. No significant correlation between opioid dose and the basal or maximum melatonin levels or the time of melatonin onset was found.

Conclusion

We found disturbances in three circadian markers after major surgery. The clinical consequences of postoperative circadian disturbances should be investigated further in the future.

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Acknowledgments

This study was supported by a research grant from the University of Copenhagen, Denmark and from the Danish Medical Research Council Jr no.22-04-0430. The authors thank Stockgrand (University of Surrey) for the supply of melatonin reagents.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, University Hospital of Copenhagen, Gentofte, Niels Andersens vej 65, DK-2900, Hellerup, Denmark

    Ismail Gögenur MD, Ubbat Ocak MD, Ömer Altunpinar MS & Jacob Rosenberg DSc

  2. Centre for Chronobiology, School of Biomedical and Molecular Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK

    Benita Middleton PhD & Debra J. Skene PhD

Authors
  1. Ismail Gögenur MD
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  2. Ubbat Ocak MD
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  3. Ömer Altunpinar MS
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  4. Benita Middleton PhD
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  5. Debra J. Skene PhD
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  6. Jacob Rosenberg DSc
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Correspondence to Ismail Gögenur MD.

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Gögenur, I., Ocak, U., Altunpinar, Ö. et al. Disturbances in Melatonin, Cortisol and Core Body Temperature Rhythms after Major Surgery. World J. Surg. 31, 290–298 (2007). https://doi.org/10.1007/s00268-006-0256-5

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  • DOI: https://doi.org/10.1007/s00268-006-0256-5

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