"Caffeine accelerates recovery from general anesthesia"

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VanDiemen said:
Any potential in this?

http://jn.physiology.org/content/111/6/1331

Strange that this wasn't tried decades ago.....
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No offense, but this is what I call a "duh" study. Obviously caffeine will only help with wake up. That's why my patients got it in the ASC, when requested, and I encouraged them to do so. But I would never give it IV, the same way I don't give theophylline IV either (if I have another choice); the risk/benefit ratio and outcomes are not that good whenever we encourage ischemia and arrhythmias. And while most patients know how much and how strong coffee they should drink, we don't, so we will probably either under- or overdose them with caffeine.
 
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Is 10 minutes not fast enough?
 
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Well, IV caffeine is no longer being manufactured so kind of a moot point.

A little trick for when you have a pt that has been on a long propofol gtt and just doesn't seem to wanna wake up. They've got great respiratory mechanics and aren't over narcotized, but they still wanna snooze. 10mg Ephedrine IV will snap them right awake. Try it.
 
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Mad Jack said:
A greater tragedy the world has never known.
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Is this a recent thing? I feel like I've given it within the past 6 months or so....maybe I'm wrong.

Also, of course caffeine would help recovery. It helps everything, except SVT.
 
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TimesNewRoman said:
Is this a recent thing? I feel like I've given it within the past 6 months or so....maybe I'm wrong.

Also, of course caffeine would help recovery. It helps everything, except SVT.
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I'm actually surprised- are they using theophylline instead to simulate respiration in noenates now?
 
Not sure what they're doing for neonates, but I've tried to order it a couple times in the past few months at separate hospitals and got the same response. I'm sure there's some residual stock still floating around out there.
 
SaltyDog said:
Not sure what they're doing for neonates, but I've tried to order it a couple times in the past few months at separate hospitals and got the same response. I'm sure there's some residual stock still floating around out there.
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I'm not sure how much of a difference it makes, but there are different caffeines. Caffeine sodium benzoate is what has been studied (the most that I know of) for PDPH, what I would be more likely to give someone caffeine for. Caffeine citrate is used for neonatal apnea. I found this out when I got a call from pharmacy in residency saying that if my order for caffeine was carried out, it'd deplete the hospitals supply of neonatal caffeine. Haha, they didn't carry the benzoate form.
 
SaltyDog said:
Well, IV caffeine is no longer being manufactured so kind of a moot point.

A little trick for when you have a pt that has been on a long propofol gtt and just doesn't seem to wanna wake up. They've got great respiratory mechanics and aren't over narcotized, but they still wanna snooze. 10mg Ephedrine IV will snap them right awake. Try it.
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I've asked several attendings to let me try this. None have been willing- so far.
 
Are they really too afraid to let you push 10mg ephedrine????? Geesh.

But honestly, why do you need to ask permission for this??
 
Yeah, you're absolutely right, I don't ask before I push ephedrine any other time. But when this situation happens the attending is usually standing right next to me, I'll say "how about some ephedrine?" The answer is usually a chuckle and then a prompt no.

I'm practicing under my attending's license, if they tell me not to do something I don't do it. Even if I happen to disagree.
 
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SaltyDog said:
Not sure what they're doing for neonates, but I've tried to order it a couple times in the past few months at separate hospitals and got the same response. I'm sure there's some residual stock still floating around out there.
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Turns out American Regent still manufactures it, but there is a shortage due to their being the only manufacturer and having to recall a large number of units due to particulate matter of unknown origin. IV caffeine is still preferred for neonatal apnea due to its once daily dosing and more predictable blood levels from what I can find, but I need to double check on UpToDate later.
 
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Just push low dose epi...
 
B-Bone said:
we use IV caffeine every day in ECT to lower seizure threshold and improve treatments.
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While I don't doubt the efficacy, this seems very unnecessary to me.

partydoc said:
Yeah, you're absolutely right, I don't ask before I push ephedrine any other time. But when this situation happens the attending is usually standing right next to me, I'll say "how about some ephedrine?" The answer is usually a chuckle and then a prompt no.

I'm practicing under my attending's license, if they tell me not to do something I don't do it. Even if I happen to disagree.
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Well do you at least press them and ask for a reason why they say no? A good attending will explain their reasoning. It's a teaching moment.
 
SaltyDog said:
While I don't doubt the efficacy, this seems very unnecessary to me.
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It is not a first line thing. Only used in pts who don't have seizure activity after multiple treatments and ramping up the energy levels. Maybe 30% of our ECT pts end up getting it over the course of their treatments.
 
SaltyDog said:
Well, IV caffeine is no longer being manufactured so kind of a moot point.

A little trick for when you have a pt that has been on a long propofol gtt and just doesn't seem to wanna wake up. They've got great respiratory mechanics and aren't over narcotized, but they still wanna snooze. 10mg Ephedrine IV will snap them right awake. Try it.
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Never heard of this before...will need to try it next time I encounter this situation.

Proposed mechanism just increased in catecholamines -> awake/fight-or-flight state I assume?
 
Wasnt there some guy in Cali that went to jail for tea bagging patients in the OR?
 
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