Caffeine Accelerates Emergence from Isoflurane Anesthesia in Humans: A Randomized, Double-blind, Crossover Study.
Caffeine Accelerates Emergence from Isoflurane Anesthesia in Humans: A Randomized, Double-blind, Crossover Study.
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DOI：
10.1097/aln.0000000000002367
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发表时间：
2018-11
期刊：
影响因子：
8.8
通讯作者：
Xie Z
中科院分区：
文献类型：
--
作者：
Fong R;Wang L;Zacny JP;Khokhar S;Apfelbaum JL;Fox AP;Xie Z
目前临床上还没有药物可以逆转全身麻醉。我们之前报道过咖啡因能够加速啮齿动物麻醉后的苏醒。这项研究是为了验证咖啡因加速人类麻醉后苏醒的假设。我们对8名健康男性进行了单中心、随机、双盲交叉研究。每个受试者用1.2%异氟醚麻醉2次，麻醉1小时。在每个疗程的最后10分钟，参与者接受了枸橼酸咖啡因（15毫克/公斤-相当于7.5毫克/公斤的咖啡因碱）或生理盐水安慰剂的静脉输注。主要终点是异氟醚停药后与生理盐水停药后出现时间的平均差异。次要结局包括妊娠时潮末异氟醚浓度；在麻醉和急救过程中测量生命体征和双谱指数。其他终点与麻醉后精神运动测试收集的数据有关。所有随机受试者均纳入分析。生理盐水组的平均苏醒时间为16.5±3.9 （SD）分钟，而咖啡因组为9.6±5.1 （SD）分钟（p =0.002），差异为6.9分钟（[1.8至12；99% CI]），减少42%。参与者在更高的异氟醚过期浓度下出现，表现出更快地恢复到基线BIS值，并且在接受咖啡因时能够更快地参加精神运动测试。服用咖啡因和咖啡因相关不良事件的生命体征没有统计学上的显著差异。在健康男性中，静脉注射咖啡因能够加速异氟醚麻醉后的苏醒，而没有任何明显的不良反应。
There are currently no drugs clinically available to reverse general anesthesia. We previously reported that caffeine is able to accelerate emergence from anesthesia in rodents. This study was carried out to test the hypothesis that caffeine accelerates emergence from anesthesia in humans. We conducted a single-center, randomized, double-blind crossover study with 8 healthy males. Each subject was anesthetized twice with 1.2% isoflurane for 1 hour. During the final 10 minutes of each session, participants received an intravenous infusion of either caffeine citrate (15 mg/kg - equivalent to 7.5 mg/kg of caffeine base) or saline placebo. The primary outcome was the average difference in time to emergence after isoflurane discontinuation between caffeine and saline sessions. Secondary outcomes included the end-tidal isoflurane concentration at emergence; and vital signs and bispectral index values measured throughout anesthesia and emergence. Additional endpoints related to data gathered from post-anesthesia psychomotor testing. All randomized participants were included in the analysis. The mean time to emergence with saline was 16.5 ± 3.9 (SD) minutes compared to 9.6 ± 5.1 (SD) minutes with caffeine (p =0.002), a difference of 6.9 minutes ([1.8 to 12; 99% CI]), a 42% reduction. Participants emerged at a higher expired isoflurane concentration, manifested more rapid return to baseline BIS values, and were able to participate in psychomotor testing sooner when receiving caffeine. There were no statistically significant differences in vital signs with caffeine administration and caffeine related adverse events. Intravenous caffeine is able to accelerate emergence from isoflurane anesthesia in healthy males without any apparent adverse effects.