The comparison of plasma orexin-a levels and emergence times from anesthesia in patients with and without insomnia who underwent elective laparoscopic cholecystectomy under general anesthesia

Objective: In the pathophysiology of insomnia, the increase of the orexin-A (OXA) peptide released from orexin neurons in the lateral hypothalamus plays an important role. Orexins takes part at the emergence of anesthesia. In the literature, we could not attain any studies about the arousal of insomnia patients from anesthesia. In this study, the effect of this peptide on the emergence process from anesthesia was investigated by comparing plasma OXA levels before and after anesthesia in insomnia patients. Materials and Methods: ASA I-II patients aged 18-65 years who underwent elective laparoscopic cholecystectomy were included in the study. Patients were evaluated with the Jenkins Sleep Disorders scale and Epworth Sleepiness scale during preoperative examination and were divided into insomnia and control groups. Blood samples were obtained for OXA and glucose levels at anesthesia induction, 5 minutes after extubation and 30 minutes after extubation. The times from stopping anesthesia to eyes opening and extubation and end-tidal sevoflurane concentrations at these time points were recorded. Results: A total of 60 patients were analyzed, including 30 in the Insomnia group and 30 in the Control group. There are no differences between age, body mass index, ASA scores between the groups (p>0.05). Duration of surgery are similar in both groups (p>0.05). The time from stopping anesthesia to eyes opening is significantly lower in the insomnia group (p<0.01). Extubation time is significantly lower in the insomnia group (p<0.05). The end-tidal sevoflurane concentration at the time of eyes opening in the insomnia group was measured as 0.17±0.14 and significantly higher compared to the control group (p<0.01). Plasma OXA levels were significantly higher in the insomnia group before anesthesia induction and (p<0.05). In both groups plasma OXA changes were significant compared to preanesthesia p<0.05). In both groups, the change in plasma OXA measurements at the 5th and 30th minutes after extubation compared to preanesthesia is similar (p=0.375; p=0.544; p>0.05, respectively). Conclusion: Insomnia patients were found to have higher levels of OXA during emergence from anesthesia, and shorter eye-opening times with verbal stimulus. As a result of these data, we believe that drug studies that target orexin receptors at the stage of emergence from anesthesia, which is considered as a passive process, will illuminate unknown aspects of the recovery process from anesthesia.