Effect of Caffeine on Time to Anesthetic Emergence after Laparoscopic Cholecystectomy: Randomized-Controlled Trial

Abstract

Background: The aim of this study was to examine the effect of caffeine on the time to emerge from sevoflurane anesthesia for laparoscopic cholecystectomy. Methods: Prospective, randomized, double-blind study conducted between July 2021 and October 2021. ASA I and II patients proposed for laparoscopic cholecystectomy were included and randomized into 2 groups at the end of the surgery to receive either 300mg of caffeine citrate infusion (C) or saline infusion (S). The main endpoint was to compare anesthetic recovery times. The secondary endpoints were recovery scales, postoperative pain, time to the first flatus, fatigue, occurrence of cardiovascular adverse events, and plasma caffeine levels one and twenty-four hours after intravenous infusion. Results: Sixty patients were included. Both groups were comparable regarding demographic characteristics and anesthesia parameters. All average times to emergence were shorter in group C with significant differences (p <0.05) for time to spontaneous ventilation (p= 0.002, -2.86 min) and time to extubation (P= 0.004, -3.51 min). In group C the modified Aldrete scale and the Richmond agitation-sedation scale were significantly higher. Fatigue was significantly lower 4 hours postoperatively with caffeine (p = 0.049). There was no difference regarding postoperative pain, headache incidence, nausea and vomiting, time to the first flatus and satisfaction at discharge from hospital. Plasma levels of caffeine were well below the toxicity threshold. Conclusion: Caffeine administration following laparoscopic cholecystectomy reduced the time to emergence and sedation. Cardiovascular adverse events were not reported and plasma levels were well below the toxicity threshold.