Caffeine for delayed recovery.

Sir,

I read with interest the postgraduate educational review on “delayed recovery from anesthesia”[1] in the May 2016 issue of your journal. Delayed recovery is a problem that every anesthesiologist will encounter sometime in his practice. At such times, a good knowledge of the causes, evaluation, and management of “delayed recovery” can be a great support. In their article, the authors have given a very elaborate account of delayed recovery from both general and regional anesthesia. I would like to add one more class of drugs – cyclic adenosine monophosphate (AMP) elevating drugs to the management of delayed recovery.

General anesthetics inhibit neurotransmitter release from both neurons and secretory cells. Intracellular cyclic AMP-elevating drugs such as forskolin, theophylline, and caffeine are known to facilitate neurotransmitter release. They were all found to dramatically accelerate recovery from isoflurane anesthesia when tested in isoflurane anesthetized rats; nevertheless, caffeine was the most effective.[2] Caffeine alone when tested on propofol anesthetized rats was found to dramatically accelerate the recovery from anesthesia.[2] In another study, intravenous 500 mg caffeine benzoate injected after the completion of surgery and the discontinuation of sevoflurane in adult patients with obstructive sleep apnea undergoing uvulopalatopharyngoplasty was found to decrease the occurrence of adverse postextubation adverse respiratory events and hastens recovery from sevoflurane anesthesia.[3] Evidence exists that caffeine might have a positive influence on early recovery of postoperative bowel activity and thus shorten hospital stay after colon surgery. Randomized controlled trials are being conducted by some researchers on this topic.[4] Caution should be exercised when administering caffeine to patients with cardiac insufficiency, cardiac arrhythmias, compromised liver function, pregnancy, and lactation.

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Conflicts of interest

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