Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of the Effect of Caffeine and Doxapram on Respiratory and Hemodynamic Parameters of Patients Admitted to the Intensive Care Unit after Spinal Surgery

Document Type : Original Article(s)

Authors
Babak Alikiee 1
Seyed taghi Hashemi 1
Mohammad Hasan Houshmandi 2
Ali Mehrabi Koushki 3
1 Associate Professor, Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Resident, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 MSc of Epidemiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v41.i740.0938
Abstract
Background: The present study was conducted to compare the effects of caffeine and doxapram on respiratory and hemodynamic parameters of patients admitted to the intensive care unit after spine surgery.
Methods: The current study is a randomized clinical trial that was performed on patients who are candidates for spine surgery at Al-Zahra Hospital in Isfahan. 90 patients who were candidates for spine surgery were divided into three groups of 30 with doxapram, caffeine, and placebo using the block randomization method (with
9 blocks). Hemodynamic variables, number of apneas, duration of apnea, and the time interval between recurrence of apnea were monitored and recorded every 6 hours to 48 hours after surgery.
Findings: The mean percentage of oxygen saturation, diastolic blood pressure, and heart rate did not show a significant difference between the three groups. However, systolic blood pressure was significantly higher in the control group. The mean number of apneas in patients and also the mean duration of apnea in the doxapram group were lower. In this regard, the time interval between the recurrence of apnea in the doxapram group was more than the other two treatment groups.
Conclusion: Doxapram had a stronger effect than caffeine in reducing the parameters of apnea duration and its number; it was also able to improve the time interval between them.
Keywords
Apnea
Caffeine
Doxapram, Hemodynamics
Respiratory system agents

Subjects

  1. Ahsaei MR, Samini F, Bahadorkhan GR. Evaluation of acute respiratory failure after cervical spinal cord injury in Mashhad Shahid Kamyab Hospital [in Persian]. Iran J Otorhinolaryngol 2010; 21(5758): 145-52.
  2. Shapiro A, Zohar E, Zaslansky R, Hoppenstein D,
    Shabat S, Fredman B. The frequency and timing of respiratory depression in 1524 postoperative patients treated with systemic or neuraxial morphine. J Clin Anesth 2005; 17(7): 537-42.
  3. Yang L, Zhu L, Shi X, Miao CH, Yuan HB, Liu ZQ, et al. Postoperative pulmonary complications in older patients undergoing elective surgery with a supraglottic airway device or tracheal intubation. Anaesthesia 2023; 78(8): 953-62.
  4. Weiss Y, Zac L, Refaeli E, Ben-Yishai S, Zegerman A, Cohen B, et al. Preoperative cognitive impairment and postoperative delirium in elderly surgical patients: A retrospective large cohort study (The CIPOD study). Ann Surg 2023; 278(1): 59-64.
  5. Osman AM, Carte SG, Carberry JC, Eckert DJ. Obstructive sleep apnea: current perspectives. Nat Sci Sleep 2018; 10: 21-34.
  6. Taylor S, Kirton OC, Staff I, Kozol RA. Postoperative day one: a high risk period for respiratory events. Am J Surg 2005; 190(5): 752-6.
  7. Rodriguez-Monguio R, Lun Z, Bongiovanni T, Chen CL, Seoane-Vazquez E. Postoperative respiratory events in surgical patients exposed to opioid analgesic shortages compared to fully matched patients non-exposed to shortages. Drug Saf 2022; 45(4): 359-67.
  8. Golder FJ, Hewitt MM, McLeod JF. Respiratory stimulant drugs in the post-operative setting. Respir Physiol Neurobiol 2013; 189(2): 395-402.
  9. Jacobson KA, Gao ZG, Matricon P, Eddy MT, Carlsson J. Adenosine A2A receptor antagonists: from caffeine to selective non‐ Br J Pharmacol 2022; 179(14): 3496-511.
  10. Warner NS, Warner MA, Schroeder DR, Sprung J, Weingarten TN. Effects of caffeine administration on sedation and respiratory parameters in patients recovering from anesthesia. Bosn J Basic Med Sci 2018; 18(1): 101-4.
  11. Mueni E, Opiyo N, English M. Caffeine for the management of apnea in preterm infants. Int Health 2009; 1(2): 190-5.
  12. Dai HR, Guo HL, Hu YH, Xu J, Ding XS, Cheng R, et al. Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up. Front Pharmacol 2022; 13: 1053210.
  13. Rae ID. Responses by Australian pharmacologists to respiratory depression caused by opiates and barbiturates. Hist Rec Aust Sci 2022; 33(1): 1-11.
  14. Henderson‐Smart DJ, Steer P. Prophylactic caffeine to prevent postoperative apnoea following general anaesthesia in preterm infants. Cochrane Database Syst Rev 2001; (4): CD000048.
  15. Naved SA, Siddiqui S, Khan FH. APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak 2011; 21(1): 4-8.
  16. Komatsu R, Sengupta P, Cherynak G, Wadhwa A, Sessler DI, Liu J, et al. Doxapram only slightly reduces the shivering threshold in healthy volunteers. Anesth Analg 2005; 101(5): 1368-73.
  17. Yost CS. A new look at the respiratory stimulant doxapram. CNS Drug Rev 2006; 12(3‐4): 236-49.
  18. Sadat Z, Salehi N, Afazel MR, Aboutalebi MS. The effect of espresso coffee consumption through gastric tube on respiratory indicators among mechanically ventilated patients: a randomized clinical trial [in Persian]. Hayat 2017; 23(2): 185-95.
  19. Gouda NM. Intravenous caffeine for adult patients with obstructive sleep apnea undergoing uvulopalatopharyngoplasty: effects on postoperative respiratory complications and recovery profile. Med J Cairo Univ 2010; 78(2): 155-9.
  20. Bamgbade OA. Advantages of doxapram for post-anaesthesia recovery and outcomes in bariatric surgery patients with obstructive sleep apnoea. Eur J Anaesthesiol 2011; 28(5): 387-8.
  21. Kim DW, Joo JD, In JH, Jeon YS, Jung HS, Jeon KB, et al. Comparison of the recovery and respiratory effects of aminophylline and doxapram following total intravenous anesthesia with propofol and remifentanil. J Clin Anesth 2013; 25(3): 173-6.
  22. Vliegenthart RJ, Hove CHT, Onland W, van Kaam AHL. Doxapram treatment for apnea of prematurity: a systematic review. Neonatology 2017; 111(2): 162-71.
Journal of Isfahan Medical School
Volume 41, Issue 740
4th Week, December
November and December 2023
Pages 938-945

  • Receive Date 12 November 2023
  • Revise Date 14 December 2023
  • Accept Date 16 December 2023