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Calcineurin Inhibitor Use and Myoclonus Association. Is There a Clinical Implication?

Open Journal of Anesthesiology 2021年第4期11卷 85-98页

作者： Ricardo E. Verdiner Ruben Casado Arroyo Mohammad Rauf Chaudhry Narjeet Khurmi Karl Poterack Andy Gorlin Arun Jayaraman Gustavo Rodriguez Department of Anesthesiology Mayo Clinic Arizona Phoenix USA Department of Medicine Universite Libre de Bruxelles Brussels Belgium Department of Neurology Texas Tech University Lubbock USA Department of Neurology Texas Tech University Health Science Center of El Paso Lubbock USA

Background: Calcineurin Inhibitors (CNIs) play a pivotal role in anti rejection therapy for transplant patients. Neurotoxicity is a known side effect that usually manifests as encephalopathy but myoclonus has also been described. Perioperative myoclonus as a manifestation of neurotoxicity, has not been well studied. Methods: We retrospectively reviewed data from 842,762 patients from the Nationwide Inpatient Sample (NIS) database from January 2011 to December 2014. Of those records we compared 56,423 patients requiring CNIs and undergoing Heart Transplant (HT) with 786,339 patients undergoing Coronary Artery Bypass Graft (CABG) surgery as controls. The objective was to study the rates of myoclonus in patients undergoing cardiac surgery, especially those requiring CNIs, and study the outcome of those patients with myoclonus. The NIS database from January 2011 to December 2014 was the source for the analysis. Patients with underlying epilepsy or hypo-ischemic encephalopathy based on ICD-9-CM codes were excluded from the study. Results: A total of 147 patients (0.26%) were found to have myoclonus in the HT group versus 338 patients (0.04%) in the CABG group, p Conclusion: In this study we have compared the rate of myoclonus found in HT patients versus CABG patients. We have identified calcineurin inhibitors as potentially contributing to myoclonus due to its neurotoxic effects. The st

关键词： Calcineurin Inhibitors Myoclonus Neurotoxicity Perioperative Mortality Renal Failure Tacrolimus Mycophenolate endothelial health Blood Brain Barrier

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