Desai Ronak, Patel Kinjal, Krishnan Sandeep, Mitrev Ludmil V, Trivedi Keyur, Torjman Marc, Goldberg Michael
Anesthesiology, Cooper University Hospital, Camden, USA.
Anesthesiology, Wayne State University School of Medicine, Detroit, USA.
Cureus. 2022 Jun 22;14(6):e26204. doi: 10.7759/cureus.26204. eCollection 2022 Jun.
Introductionː Postoperative cognitive dysfunction has long-term consequences of increased mortality, loss of autonomy, and prolonged hospitalization. We sought to determine whether exposing patients to modafinil may attenuate or prevent this devastating syndrome from affecting the elderly postoperatively. Methodsː Adults aged 65 and older and American Society of Anesthesiologists (ASA) I-III physical status scheduled for elective noncardiac/non-neurosurgical surgery were included. Subjects were tested with the Trail Making Test (TMT) and Rey Auditory Visual Learning Test (RAVLT) preoperatively as well as in the immediate postoperative period, at 1 week, and at 3 months. After baseline testing, patients were randomized into three groups: 0) placebo pre and post-procedure; 1) modafinil only pre-procedure and placebo post-procedure; and 2) modafinil pre and post-procedure. A nonsurgical control group was also utilized. Resultsː Seventy-six subjects completed the trial 3 months post-surgery. The baseline RAVLT obtained was analyzed with 2-way ANOVA with repeated measures and showed improvement in learning in all groups (p = 0.03). At 1-week post-surgery, Group 0 subjects demonstrated no learning improvement in the RAVLT. However, there was a significant improvement in learning in both groups that received modafinil (p<0.01), and in the nonsurgical controls (p<0.01). This learning benefit normalized at 3 months. Conclusionː In this prospective, double-blind, placebo-controlled trial, we found that patients who received modafinil showed improvement in the RAVLT at 1 week. However, this learning benefit normalized at 3 months. Further study should examine dose effect, timing, and route of administration to determine if the effect can be enhanced and if in fact, wakefulness is improved post-surgically.
术后认知功能障碍具有死亡率增加、自主性丧失和住院时间延长等长期后果。我们试图确定让患者服用莫达非尼是否可以减轻或预防这种破坏性综合征对老年人术后的影响。方法：纳入年龄在65岁及以上、美国麻醉医师协会（ASA）身体状况为I-III级、计划进行择期非心脏/非神经外科手术的成年人。术前以及术后即刻、1周和3个月时，使用连线测验（TMT）和雷伊听觉视觉学习测验（RAVLT）对受试者进行测试。在基线测试后，患者被随机分为三组：0）术前和术后均使用安慰剂；1）术前仅使用莫达非尼，术后使用安慰剂；2）术前和术后均使用莫达非尼。还设立了一个非手术对照组。结果：76名受试者在术后3个月完成了试验。对获得的基线RAVLT进行重复测量的双向方差分析，结果显示所有组的学习能力均有改善（p = 0.03）。术后1周时，0组受试者在RAVLT中未表现出学习能力的改善。然而，接受莫达非尼的两组以及非手术对照组的学习能力均有显著改善（p<0.01）。这种学习益处在3个月时恢复正常。结论：在这项前瞻性、双盲、安慰剂对照试验中，我们发现接受莫达非尼的患者在1周时RAVLT有改善。然而，这种学习益处在3个月时恢复正常。应进一步研究剂量效应、给药时间和途径，以确定是否可以增强这种效应，以及术后清醒度是否确实得到改善。
