Prevention of Postoperative Cognitive Dysfunction by Minocycline in Elderly Patients after Total Knee Arthroplasty: A Randomized, Double-blind, Placebo-controlled Clinical Trial
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- Tomonori Takazawa
- 1Intensive Care Unit, Gunma University Hospital, Maebashi, Japan.
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- Tatsuo Horiuchi
- 2Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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- Masaki Orihara
- 3Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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- Kazuhiro Nagumo
- 4Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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- Akihiro Tomioka
- 5Department of Anesthesiology, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan.
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- Yuki Ideno
- 6Gunma University Initiative for Advanced Research, Maebashi, Japan.
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- Kunihiko Hayashi
- 7Graduate School of Health Science, Gunma University, Maebashi, Japan.
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- Hideaki Yashima
- 8Department of Pharmacy, Gunma University Hospital, Maebashi, Japan.
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- Takuya Araki
- 9Department of Pharmacy, Gunma University Hospital, Maebashi, Japan.
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- Kazuhisa Hatayama
- 10Department of Orthopedic Surgery, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Japan.
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- Masanori Terauchi
- 11Department of Orthopedic Surgery, Japan Community Healthcare organization, Gunma Chuo Hospital, Maebashi, Japan.
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- Yoshio Ikeda
- 12Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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- Shigeru Saito
- 13Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan.
説明
<jats:sec> <jats:title>Background</jats:title> <jats:p>There are no effective pharmacologic interventions for preventing postoperative cognitive dysfunction in daily practice. Since the antibiotic minocycline is known to suppress postoperative neuroinflammation, this study hypothesized and investigated whether minocycline might have a preventive effect on postoperative cognitive dysfunction after noncardiac surgery.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This study included patients aged more than 60 yr undergoing total knee arthroplasty under general anesthesia. They were randomly assigned to minocycline and placebo groups, to orally receive 100 mg of minocycline or placebo twice daily from the day before surgery until the seventh day after surgery. Cognitive function was evaluated before surgery, and 1 week and 3 months after surgery, using a battery of four cognitive function tests, including Visual Verbal Learning Test, Trail Making Test, Stroop Color and Word Test, and Letter–Digit Coding Task. Additionally, 30 healthy volunteers were subjected to the same tests as the patients to examine the learning effect of repeated tests. The occurrence of postoperative cognitive dysfunction was judged from the results of the neurocognitive test battery, with consideration of the learning effect. The secondary endpoints were the effects of minocycline on postoperative delirium and postoperative pain.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 100 patients were randomized to the minocycline group, and 102 were randomized to the placebo group. The average age of patients was 75 yr. Evaluation showed no significant difference in the incidence of postoperative cognitive dysfunction between the minocycline and placebo groups at both 1 week (8 of 90 [8.9%] vs. 4 of 95 [4.2%]; odds ratio, 2.22 [95% CI, 0.64 to 7.65]; P = 0.240) and 3 months (15.3 of 90 [17.0%] vs. 15.3 of 95 [16.1%]; odds ratio, 1.07 [95% CI, 0.49 to 2.32]; P = 0.889) postoperatively. Missing data 3 months after surgery were corrected by the multiple imputation method. There were no differences between the two groups in postoperative delirium and postoperative pain.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Minocycline is likely to have no preventive effect on postoperative cognitive dysfunction.</jats:p> </jats:sec> <jats:sec> <jats:title>Editor’s Perspective</jats:title> <jats:sec> <jats:title>What We Already Know about This Topic</jats:title> </jats:sec> <jats:sec> <jats:title>What This Article Tells Us That Is New</jats:title> </jats:sec> </jats:sec>
収録刊行物
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- Anesthesiology
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Anesthesiology 138 (2), 172-183, 2022-12-13
Ovid Technologies (Wolters Kluwer Health)
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詳細情報 詳細情報について
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- CRID
- 1360580229814707456
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- ISSN
- 15281175
- 00033022
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- データソース種別
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