The effect of preoperative aminophylline on the recovery profile after major pelvic-abdominal surgeries: a randomized controlled double-blinded study

Samaa A Kasim, Mahmoud Hussein Bahr, Mohamed Abdelkader, Doaa Abu Elkassim Rashwan, Samaa A Kasim, Mahmoud Hussein Bahr, Mohamed Abdelkader, Doaa Abu Elkassim Rashwan

Abstract

Background: This study compared the effects of premedication with different doses of aminophylline on the recovery profile after general anaesthesia.

Methods: Forty-five patients scheduled for pelvic-abdominal surgeries were divided into 3 groups: Group C: the patients received 100 ml of IV normal saline, Group A1: the patients received 2 mg/kg IV aminophylline, and Group A2: the patients received 4 mg/kg IV aminophylline 30 min before induction of general anaesthesia. The following data were recorded: demographic data, ASA physical status, duration of anaesthesia and surgery, heart rate, mean arterial blood pressure, propofol dose, fentanyl dose, times to reach BIS (48 ± 2) after induction of anaesthesia and to reach a value of 80 after discontinuation of sevoflurane anaesthesia, time to recovery of consciousness and to tracheal extubation and to discharge from the post-anaesthesia care unit, and side effects of aminophylline.

Results: The time to reach a BIS of 48 ± 2 was significantly lower for the control group than group A2 (70.67 ± 22.50 and 106.67 ± 34.77 s for groups C and A2, respectively, p -value =0.01). The time to reach a BIS of 80 was significantly longer for the control group than group A1 andA2 (5.6 ± 1.40,3.5 ± 1.93and 2.53 ± 1.72 min for groups C,A1 and A2, respectively, p -value < 0.01). The time to ROC was significantly longer for the control group than groups A1 and A2 (8.93 ± 0.92, 5.6 ± 2.47 and 4.53 ± 3.33 min for groups C, A1 and A2, respectively; p -value < 0.01). The extubation time was significantly longer for the control group than groups A1 and A2 (12.4 ± 1.08, 7.87 ± 3.27 and 6.6 ± 2.47 min for groups C, A1 and A2, respectively; p -value < 0.01).

Conclusion: Premedication with aminophylline enhanced the recovery profile after pelvic-abdominal surgeries under general anaesthesia without cardiovascular complications.

Clinical trial registration: Name of the registry: Register@ClinicalTrials.gov Trial registration number: ClinicalTrials.gov Identifier: NCT04151381. Date of registration, November 5, 2019, 'Retrospectively registered'.

Keywords: Adenosine; Aminophylline; BIS.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow diagram

References

    1. Niemand D, Martinell S, Arvidsson S, Ekström-Jodal B, Svedmyr N. Adenosine in the inhibition of diazepam sedation by aminophylline. Acta Anaesthesiol Scand. 1986;30(7):493–495. doi: 10.1111/j.1399-6576.1986.tb02462.x.
    1. Krintel JJ, Wegmann F. Aminophylline reduces the depth and duration of sedation with barbiturates. Acta Anaesthesiol Scand. 1987;31(4):352–354. doi: 10.1111/j.1399-6576.1987.tb02582.x.
    1. Turan A, Memiş D, Karamanlioglu B, Colak A, Pamukçu Z, Turan N. Effect of aminophylline on recovery from sevoflurane anaesthesia. Eur J Anaesthesiol. 2002;19(06):452–454. doi: 10.1017/S0265021502000728.
    1. Stirt JA. Aminophylline may act as a morphine antagonist. Anaesthesia. 1983;38(3):275–278. doi: 10.1111/j.1365-2044.1983.tb13990.x.
    1. Turan A, Kasuya Y, Govinda R, Obal D, Rauch S, Dalton JE, Akça O, Sessler DI. The effect of aminophylline on loss of consciousness, bispectral index, propofol requirement, and minimum alveolar concentration of desflurane in volunteers. Anesth Analg. 2010;110(2):449–454. doi: 10.1213/ANE.0b013e3181c6be7e.
    1. Sakurai S, Fukunaga A, Fukuda K, Kasahara M, Ichinohe T, Kaneko Y. Aminophylline reversal of prolonged postoperative sedation induced by propofol. J Anesth. 2008;22(1):86–88. doi: 10.1007/s00540-007-0587-x.
    1. Piafsky KM, Ogilvie RI. Dosage of theophylline in bronchial asthma. N Engl J Med. 1975;292(23):1218–1222. doi: 10.1056/NEJM197506052922305.
    1. Stirt JA. Aminophylline is a diazepam antagonist. Anesth Analg. 1981;60(10):767–768. doi: 10.1213/00000539-198110000-00016.
    1. Turan A, Memiş D, Karamanlýodthlu B, Pamukçu Z, Süt N. Effect of aminophylline on bispectral index. Acta Anaesthesiol Scand. 2004;48(4):408–411. doi: 10.1111/j.0001-5172.2004.00350.x.
    1. Gürel A, Elevli M, Hamulu A. Aminophylline reversal of flunitrazepam sedation. Anesth Analg. 1987;66(4):333–336.
    1. El Tahan MR. Effects of aminophylline on cognitive recovery after sevoflurane anesthesia. J Anesth. 2011;25(5):648–656. doi: 10.1007/s00540-011-1190-8.
    1. Arya S, Asthana V, Sharma JP. Clinical vs. bispectral index-guided propofol induction of anesthesia: a comparative study. Saudi J Anaesth. 2013;7(1):75–79. doi: 10.4103/1658-354X.109819.
    1. Hoshino T, Toda R, Aizawa H. Pharmacological treatment in asthma and COPD. Allergol Int. 2009;58(3):341–346. doi: 10.2332/allergolint.09-RAI-0117.
    1. Zhang JM, Wang F, Xin Z, Lü H. Effectiveness of bispectral index in intravenous anesthesia with remifentanil and propofol in children. Zhonghua Yi Xue Za Zhi. 2008;88(41):2904–2906.
    1. Huang ZL, Qu WM, Eguchi N, Chen JF, Schwarzschild MA, Fredholm BB, Urade Y, Hayaishi O. Adenosine A2A, but not A1, receptors mediate the arousal effect of caffeine. Nat Neurosci. 2005;8(7):858–859. doi: 10.1038/nn1491.
    1. Basheer R, Strecker RE, Thakkar MM, McCarley RW. Adenosine and sleep-wake regulation. Prog Neurobiol. 2004;73(6):379–396. doi: 10.1016/j.pneurobio.2004.06.004.
    1. Tanase D, Baghdoyan HA, Lydic R. Dialysis delivery of an adenosine A1 receptor agonist to the pontine reticular formation decreases acetylcholine release and increases anesthesia recovery time. Anesthesiology. 2003;98(4):912–920. doi: 10.1097/00000542-200304000-00018.
    1. Tung A, Herrera S, Szafran MJ, Kasza K, Mendelson WB. Effect of sleep deprivation on righting reflex in the rat is partially reversed by administration of adenosine A1 and A2 receptor antagonists. Anesthesiology. 2005;102(6):1158–1164. doi: 10.1097/00000542-200506000-00015.
    1. Kaputlu I, Sadan G, Ozdem S. Exogenous adenosine potentiates hypnosis induced by intravenous anaesthetics. Anaesthesia. 1998;53(5):496–500. doi: 10.1046/j.1365-2044.1998.00330.x.
    1. Ghaffaripour S, Khosravi MB, Rahimi A, Sahmedini MA, Chohedri A, Mahmoudi H, Kazemi MR. The effects of aminophylline on clinical recovery and bispectral index in patients anesthetized with total intravenous anaesthesia. Pak J Med Sci. 2014;30(6):1351–1355. doi: 10.12669/pjms.306.5853.
    1. Hüpfl M, Schmatzer I, Buzath A, Burger H, Hörauf K, Ihra G, Marhofer P, Nagele P. The effects of aminophylline on bispectral index during inhalational and total intravenous anaesthesia. Anaesthesia. 2008;63(6):583–587. doi: 10.1111/j.1365-2044.2008.05445.x.
    1. Aghabiklooei A. The efficacy of aminophylline on raising consciousness in benzodiazepines-intoxicated patients. Asia Pac J Med Toxicol. 2018;7:17–19.
    1. Imani F, Ahmadi TA, Shariat MR, Etezadi F, Pourfakhr P, Khajavi MR. A comparison of the effects of low and high doses of aminophylline on recovery time and the bispectral index score following iso flurane anesthesia. Iran Red Crescent Med J. 2017;19:e32763.

Source: PubMed

3
Suscribir