Effects of aminophylline on cognitive recovery after sevoflurane anesthesia

J Anesth. 2011 Oct;25(5):648-56. doi: 10.1007/s00540-011-1190-8. Epub 2011 Jul 14.

Abstract

Purpose: Aminophylline accelerates the recovery from sevoflurane anesthesia. We studied the effects of escalating doses of aminophylline on cognitive and clinical recovery after sevoflurane anesthesia.

Methods: After ethical approval and informed consent, 150 patients scheduled for elective surgery under sevoflurane-fentanyl anesthesia were randomly allocated to receive saline or 2, 3, 4 or 5 mg/kg of aminophylline (n = 30 for each) at the end of anesthesia (T (0)). Short Orientation Memory Concentration Test (SOMCT) scores, entropy values, end-tidal sevoflurane concentrations (EtSevo), times to eyes opening and extubation, respiratory rate (RR) and tidal volume (TV) were recorded.

Results: Compared to placebo, patients receiving 2, 3, 4 and 5 mg/kg of aminophylline had higher SOMCT scores [median (25th percentile/75th percentile) 20.6 (19/23), 21.5 (21/22), 24.5 (24-25), 25.5 (25/26), respectively, vs. 13.5 (13/14) at 30 min after extubation, and 24 (22/26), 25 (24/26), 27.5 (27-28), 27.5 (27/28), respectively, vs. 18.5 (18/19) at 45 min after extubation], higher entropy values for the first 10 min after T (0), lower EtSevo for the first 4 min after T (0), shorter times to eyes opening [5 (4.0/6.0), 5 (4.0/6.0), 4 (2.0/5.5), and 4 (2.0/6.0), respectively, vs. 9.8 (8.0/11.0) min], shorter times to extubation, shorter times to home discharge (P < 0.001), and higher RR and larger TV values. Patients who received 4 and 5 mg/kg of aminophylline showed higher SOMCT scores, 6 min shorter times to eyes opening and to extubation, and 58 min shorter times to home discharge.

Conclusion: The administration of escalating doses of aminophylline accelerates postoperative cognitive recovery from sevoflurane anesthesia, as measured by the SOMCT, due to increased ventilatory elimination of sevoflurane.

Trial registration: ClinicalTrials.gov NCT01022151.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aminophylline / therapeutic use*
  • Anesthesia Recovery Period*
  • Anesthesia, General / methods
  • Anesthetics, Inhalation / administration & dosage*
  • Anesthetics, Intravenous / administration & dosage*
  • Cognition / drug effects*
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Female
  • Fentanyl / pharmacology
  • Humans
  • Male
  • Methyl Ethers / administration & dosage*
  • Placebos / administration & dosage
  • Prospective Studies
  • Purinergic P1 Receptor Antagonists / therapeutic use*
  • Sevoflurane

Substances

  • Anesthetics, Inhalation
  • Anesthetics, Intravenous
  • Methyl Ethers
  • Placebos
  • Purinergic P1 Receptor Antagonists
  • Aminophylline
  • Sevoflurane
  • Fentanyl

Associated data

  • ClinicalTrials.gov/NCT01022151