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Deljou A, Sprung J, Soleimani J, Schroeder DR, Weingarten TN. Caffeine administration to treat oversedation after general anesthesia: A retrospective analysis. J Clin Anesth 2024; 92:111321. [PMID: 37976682 DOI: 10.1016/j.jclinane.2023.111321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/05/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
STUDY OBJECTIVE Our institution has adopted an informal practice of administering postoperative caffeine to expedite anesthesia recovery for patients with excessive sedation. This study aimed to determine whether caffeine administration was associated with improved sedation recovery and reduced risk of respiratory complications. DESIGN Single-center, retrospective, observational study. SETTING Quaternary medical center. PATIENTS We included adult patients who were admitted to a postanesthesia recovery care unit (PACU) after general anesthesia and had evidence of postoperative sedation (Richmond Agitation Sedation Score [RASS] < 0). Patients were seen from May 5, 2018, through December 31, 2020. INTERVENTIONS Patients were categorized according to caffeine administration (0 vs 250 mg). MEASUREMENTS Sedation was measured with RASS. To account for potential confounding, binary and ordinal logistic regression with inverse probability of treatment weighting (IPTW) were used to compare RASS and episodes of severe respiratory complications within 48 h after PACU discharge. MAIN RESULTS We identified 47,222 adult surgical patients with evidence of sedation in the PACU, and of these, 1892 (4.0%) were intravenously administered caffeine. Patients who received caffeine had more sedation in the PACU. In the IPTW-adjusted analysis, caffeine administration was associated with improved sedation scores after PACU discharge (ordinal logistic regression odds ratio [OR], 1.13 [95% CI, 1.00-1.28]; P = .04 for the first RASS score after PACU discharge) but increased risk of respiratory complications (OR, 2.99 [95% CI, 1.44-6.24]; P = .003) and emergency response team activation (OR, 7.18 [95% CI, 2.85-18.10]; P < .001). CONCLUSIONS In this observational study, caffeine administration during anesthesia recovery was associated with improved sedation scores. However, it was also associated with an increased risk of respiratory complications, possibly reflecting selection bias (ie, administering caffeine to higher-risk patients). Patients with signs of excessive sedation during anesthesia recovery may benefit from enhanced postoperative respiratory monitoring.
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Affiliation(s)
- Atousa Deljou
- Department of Anesthesiology and Perioperative Medicine, United States of America.
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, United States of America
| | - Jalal Soleimani
- Mayo Clinic, Rochester, MN, United States of America; Research Fellow in the Department of Anesthesiology and Perioperative Medicine, United States of America; Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, United States of America
| | | | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, United States of America
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Gjini K, Casey C, Kunkel D, Her M, Banks MI, Pearce RA, Lennertz R, Sanders RD. Delirium is associated with loss of feedback cortical connectivity. Alzheimers Dement 2024; 20:511-524. [PMID: 37695013 PMCID: PMC10840828 DOI: 10.1002/alz.13471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Post-operative delirium (POD) is associated with increased morbidity and mortality but is bereft of treatments, largely due to our limited understanding of the underlying pathophysiology. We hypothesized that delirium reflects a disturbance in cortical connectivity that leads to altered predictions of the sensory environment. METHODS High-density electroencephalogram recordings during an oddball auditory roving paradigm were collected from 131 patients. Dynamic causal modeling (DCM) analysis facilitated inference about the neuronal connectivity and inhibition-excitation dynamics underlying auditory-evoked responses. RESULTS Mismatch negativity amplitudes were smaller in patients with POD. DCM showed that delirium was associated with decreased left-sided superior temporal gyrus (l-STG) to auditory cortex feedback connectivity. Feedback connectivity also negatively correlated with delirium severity and systemic inflammation. Increased inhibition of l-STG, with consequent decreases in feed-forward and feed-back connectivity, occurred for oddball tones during delirium. DISCUSSION Delirium is associated with decreased feedback cortical connectivity, possibly resulting from increased intrinsic inhibitory tone. HIGHLIGHTS Mismatch negativity amplitude was reduced in patients with delirium. Patients with postoperative delirium had increased feedforward connectivity before surgery. Feedback connectivity was diminished from left-side superior temporal gyrus to left primary auditory sensory area during delirium. Feedback connectivity inversely correlated with inflammation and delirium severity.
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Affiliation(s)
- Klevest Gjini
- Department of NeurologyUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Cameron Casey
- Department of AnesthesiologyUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Pediatric Neuromodulation Laboratory, Waisman CenterUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - David Kunkel
- Department of AnesthesiologyUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Maihlee Her
- Department of AnesthesiologyUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Matthew I. Banks
- Department of AnesthesiologyUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Department of NeuroscienceUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Robert A. Pearce
- Department of AnesthesiologyUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Richard Lennertz
- Department of AnesthesiologyUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Robert D. Sanders
- Department of Anaesthetics & Institute of Academic SurgeryRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- NHMRC Clinical Trials Centre and Central Clinical SchoolUniversity of SydneyCamperdownNew South WalesAustralia
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3
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Vlisides PE, Li D, Maywood M, Zierau M, Lapointe AP, Brooks J, McKinney AM, Leis AM, Mentz G, Mashour GA. Electroencephalographic Biomarkers, Cerebral Oximetry, and Postoperative Cognitive Function in Adult Noncardiac Surgical Patients: A Prospective Cohort Study. Anesthesiology 2023; 139:568-579. [PMID: 37364282 PMCID: PMC10592490 DOI: 10.1097/aln.0000000000004664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Perioperative neurocognitive disorders are a major public health issue, although there are no validated neurophysiologic biomarkers that predict cognitive function after surgery. This study tested the hypothesis that preoperative posterior electroencephalographic alpha power, alpha frontal-parietal connectivity, and cerebral oximetry would each correlate with postoperative neurocognitive function. METHODS This was a single-center, prospective, observational study of adult (older than 18 yr) male and female noncardiac surgery patients. Whole-scalp, 16-channel electroencephalography and cerebral oximetry were recorded in the preoperative, intraoperative, and immediate postoperative settings. The primary outcome was the mean postoperative T-score of three National Institutes of Health Toolbox Cognition tests-Flanker Inhibitory Control and Attention, List Sorting Working Memory, and Pattern Comparison Processing Speed. These tests were obtained at preoperative baseline and on the first two postoperative mornings. The lowest average score from the first two postoperative days was used for the primary analysis. Delirium was a secondary outcome (via 3-min Confusion Assessment Method) measured in the postanesthesia care unit and twice daily for the first 3 postoperative days. Last, patient-reported outcomes related to cognition and overall well-being were collected 3 months postdischarge. RESULTS Sixty-four participants were recruited with a median (interquartile range) age of 59 (48 to 66) yr. After adjustment for baseline cognitive function scores, no significant partial correlation (ρ) was detected between postoperative cognition scores and preoperative relative posterior alpha power (%; ρ = -0.03, P = 0.854), alpha frontal-parietal connectivity (via weight phase lag index; ρ = -0.10, P = 0.570, respectively), or preoperative cerebral oximetry (%; ρ = 0.21, P = 0.246). Only intraoperative frontal-parietal theta connectivity was associated with postoperative delirium (F[1,6,291] = 4.53, P = 0.034). No electroencephalographic or oximetry biomarkers were associated with cognitive or functional outcomes 3 months postdischarge. CONCLUSIONS Preoperative posterior alpha power, frontal-parietal connectivity, and cerebral oximetry were not associated with cognitive function after noncardiac surgery. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Phillip E. Vlisides
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, MI USA
| | - Duan Li
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI USA
| | - Michael Maywood
- Department of Ophthalmology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Mackenzie Zierau
- College of Health Professions, University of Detroit Mercy, Detroit, MI USA
| | - Andrew P. Lapointe
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Joseph Brooks
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI USA
| | - Amy M. McKinney
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI USA
| | - Aleda M. Leis
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Graciela Mentz
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI USA
| | - George A. Mashour
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, MI USA
- Neuroscience Graduate Program, University of Michigan Medical School, Ann Arbor, MI USA
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Ragheb J, Norcott A, Benn L, Shah N, McKinney A, Min L, Vlisides PE. Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives. BMC Health Serv Res 2023; 23:712. [PMID: 37386400 DOI: 10.1186/s12913-023-09681-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/10/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Delirium in hospitalized patients is a major public health issue, yet delirium is often unrecognized and missed during inpatient admission. The objective of this study was to identify barriers to delirium screening, identification, and management from a nursing perspective on inpatient, acute care units. METHODS This was a pre-implementation, diagnostic evaluation study to determine current practice patterns and potential barriers to optimizing delirium care at a major university hospital. A qualitative approach was used, which included focus groups of inpatient nurses working on major medical and surgical acute care units. Focus groups were conducted until signs of thematic saturation were present, and data were analyzed via inductive thematic analysis, without predetermined theories or structures. A consensus approach was utilized for transcript coding, and final themes were generated after multiple reviews of initial themes against transcript datasets. RESULTS Focus group sessions (n = 3) were held with 18 nurses across two major inpatient units. Nurses reported several barriers to successful delirium screening and management. Specific challenges included difficulty with using delirium screening tools, an organizational culture not conducive to delirium prevention, and competing clinical priorities. Proposed solutions were also discussed, including decision-support systems with automated pager alerts and associated delirium order sets, which may help improve delirium care coordination and standardization. CONCLUSION At a major university hospital, nurses affirm the difficulty experienced with delirium screening and identification, particularly due to screening tool challenges, cultural barriers, and clinical workload. These impediments may serve as targets for a future implementation trial to improve delirium screening and management.
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Affiliation(s)
- Jacqueline Ragheb
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Alexandra Norcott
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Lakeshia Benn
- Department of Inpatient Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
- College of Health Professions & McAuley School of Nursing, University of Detroit Mercy, Detroit, MI, USA
| | - Nirav Shah
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Amy McKinney
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA
| | - Lillian Min
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, Michigan Medicine, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Department of Internal Medicine, Division of Geriatric Research, Education, and Clinical Centers (GRECC), Ann Arbor, MI, USA
| | - Phillip E Vlisides
- Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, 1500 East Medical Center Drive, Ann Arbor, MI, SPC-5048, 48109-5048, USA.
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, USA.
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Vlisides PE, Ragheb J, McKinney A, Mentz G, Runstadler N, Martinez S, Jewell E, Lee U, Vanini G, Schmitt EM, Inouye SK, Mashour GA. Caffeine, Postoperative Delirium And Change In Outcomes after Surgery (CAPACHINOS)-2: protocol for a randomised controlled trial. BMJ Open 2023; 13:e073945. [PMID: 37188468 PMCID: PMC10186430 DOI: 10.1136/bmjopen-2023-073945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Delirium is a major public health issue for surgical patients and their families because it is associated with increased mortality, cognitive and functional decline, prolonged hospital admission and increased healthcare expenditures. Based on preliminary data, this trial tests the hypothesis that intravenous caffeine, given postoperatively, will reduce the incidence of delirium in older adults after major non-cardiac surgery. METHODS AND ANALYSIS The CAffeine, Postoperative Delirium And CHange In Outcomes after Surgery-2 (CAPACHINOS-2) Trial is a single-centre, placebo-controlled, randomised clinical trial that will be conducted at Michigan Medicine. The trial will be quadruple-blinded, with clinicians, researchers, participants and analysts all masked to the intervention. The goal is to enrol 250 patients with a 1:1:1: allocation ratio: dextrose 5% in water placebo, caffeine 1.5 mg/kg and caffeine 3 mg/kg as a caffeine citrate infusion. The study drug will be administered intravenously during surgical closure and on the first two postoperative mornings. The primary outcome will be delirium, assessed via long-form Confusion Assessment Method. Secondary outcomes will include delirium severity, delirium duration, patient-reported outcomes and opioid consumption patterns. A substudy analysis will also be conducted with high-density electroencephalography (72-channel system) to identify neural abnormalities associated with delirium and Mild Cognitive Impairment at preoperative baseline. ETHICS AND DISSEMINATION This study was approved by the University of Michigan Medical School Institutional Review Board (HUM00218290). An independent data and safety monitoring board has also been empanelled and has approved the clinical trial protocol and related documents. Trial methodology and results will be disseminated via clinical and scientific journals along with social and news media. TRIAL REGISTRATION NUMBER NCT05574400.
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Affiliation(s)
- Phillip E Vlisides
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Amy McKinney
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Graciela Mentz
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | | | | | | | - UnCheol Lee
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan, USA
| | - Giancarlo Vanini
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan, USA
| | - Eva M Schmitt
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, USA
| | - George A Mashour
- Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan, USA
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Bodnar RJ. Endogenous opiates and behavior: 2021. Peptides 2023; 164:171004. [PMID: 36990387 DOI: 10.1016/j.peptides.2023.171004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
This paper is the forty-fourth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2021 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonizts and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY 11367, USA.
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Affiliation(s)
- Hyoungkyu Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - UnCheol Lee
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan,USA
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, Michigan,USA
| | - Phillip E Vlisides
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan,USA
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, Michigan,USA
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Tanabe S, Parker M, Lennertz R, Pearce RA, Banks MI, Sanders RD. Delirium and Cortical Complexity: Divergent Changes in Alpha and Theta Bands. J Gerontol A Biol Sci Med Sci 2022; 77:2221-2222. [PMID: 35943896 PMCID: PMC9678193 DOI: 10.1093/gerona/glac165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Sean Tanabe
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maggie Parker
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Richard Lennertz
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Matthew I Banks
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Sydney, New South Wales, Australia
- Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, , New South Wales, Australia
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Trouvin AP, Attal N, Perrot S. Lifestyle and chronic pain: double jeopardy? Br J Anaesth 2022; 129:278-281. [PMID: 35803752 DOI: 10.1016/j.bja.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
Given the often disappointing results of pharmacotherapy, many patients with chronic pain seek to modify their lifestyle. Some lifestyle factors, such as the consumption of alcohol, tobacco, cannabis, or psychostimulants, are deleterious in this context, whereas others, such as physical activity and a balanced diet, are considered beneficial, but these require substantial effort on the part of patients. In all cases, it is important to analyse lifestyle factors in patients with chronic pain, without stigmatisation, as the co-existence of pain and inappropriate behaviour can be seen as double jeopardy in patients with pain.
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Affiliation(s)
- Anne-Priscille Trouvin
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Cochin, Université Paris Cité, INSERM U987, Paris, France; CETD and INSERM U987, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Paris Saclay University, Versailles, France
| | - Nadine Attal
- CETD and INSERM U987, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Paris Saclay University, Versailles, France
| | - Serge Perrot
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Cochin, Université Paris Cité, INSERM U987, Paris, France; CETD and INSERM U987, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
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Boppana SH, Peterson M, Du A, Gabriel RA, Kutikuppala LVS. Caffeine: What Is Its Role in Pain Medicine? Cureus 2022; 14:e25603. [PMID: 35795518 PMCID: PMC9250334 DOI: 10.7759/cureus.25603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Caffeine is the world's most widely used psychoactive legal substance. The involvement of caffeine in pain management has gotten minimal attention in the past, but it is getting more attention now. This article provides a brief assessment of the literature to clarify the role of caffeine as a pain reliever and stimulate the interest of researchers. Caffeine affects adenosine receptors, which are involved in nociception, and plays a significant role in pain regulation. Caffeine's usage as an adjuvant therapy has been extensively documented in the literature, and it is now accessible in certain over-the-counter drugs. The mixture of coffee and morphine for pain reduction in individuals with terminal cancer has shown mixed outcomes in studies. Caffeine can be utilized for hypnic headaches and post-dural puncture headaches since it is crucial in pain regulation. Caffeine has the potential to help in pain management. Caffeine's usage for migraines and end-stage cancer disease is not well acknowledged. Further research is essential to focus on caffeine's potential role in various forms of pain, including dosage escalation and outcome assessment standardization.
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Kim H, McKinney A, Brooks J, Mashour GA, Lee U, Vlisides PE. Delirium, Caffeine, and Perioperative Cortical Dynamics. Front Hum Neurosci 2022; 15:744054. [PMID: 34987367 PMCID: PMC8722672 DOI: 10.3389/fnhum.2021.744054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/30/2021] [Indexed: 12/19/2022] Open
Abstract
Delirium is a major public health issue associated with considerable morbidity and mortality, particularly after surgery. While the neurobiology of delirium remains incompletely understood, emerging evidence suggests that cognition requires close proximity to a system state called criticality, which reflects a point of dynamic instability that allows for flexible access to a wide range of brain states. Deviations from criticality are associated with neurocognitive disorders, though the relationship between criticality and delirium has not been formally tested. This study tested the primary hypothesis that delirium in the postanesthesia care unit would be associated with deviations from criticality, based on surrogate electroencephalographic measures. As a secondary objective, the impact of caffeine was also tested on delirium incidence and criticality. To address these aims, we conducted a secondary analysis of a randomized clinical trial that tested the effects of intraoperative caffeine on postoperative recovery in adults undergoing major surgery. In this substudy, whole-scalp (16-channel) electroencephalographic data were analyzed from a subset of trial participants (n = 55) to determine whether surrogate measures of neural criticality – (1) autocorrelation function of global alpha oscillations and (2) topography of phase relationships via phase lag entropy – were associated with delirium. These measures were analyzed in participants experiencing delirium in the postanesthesia care unit (compared to those without delirium) and in participants randomized to caffeine compared to placebo. Results demonstrated that autocorrelation function in the alpha band was significantly reduced in delirious participants, which is important given that alpha rhythms are postulated to play a vital role in consciousness. Moreover, participants randomized to caffeine demonstrated increased alpha autocorrelation function concurrent with reduced delirium incidence. Lastly, the anterior-posterior topography of phase relationships appeared most preserved in non-delirious participants and in those receiving caffeine. These data suggest that early postoperative delirium may reflect deviations from neural criticality, and caffeine may reduce delirium risk by shifting cortical dynamics toward criticality.
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Affiliation(s)
- Hyoungkyu Kim
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Amy McKinney
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Joseph Brooks
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - George A Mashour
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
| | - UnCheol Lee
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Phillip E Vlisides
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
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