Caffeine in children with obstructive sleep apnea.
BACKGROUND
Children with obstructive sleep apnea (OSA) have a higher rate of adverse post-extubation respiratory events, such as laryngospasm, upper airway obstruction, apnea, desaturation and/or need for re-intubation. They are overly sensitive to sedatives and narcotics. Although the etiology of OSA is primarily obstruction (mechanical or neuromuscular), a central element may contribute to OSA. Caffeine citrate has been shown to be effective in treating apnea of prematurity. This study evaluated whether the administration of caffeine benzoate to children with OSA decreases the number of children who experience adverse post-extubation respiratory events.


METHODS
In a randomized, double-blind and placebo-controlled study, children with OSA scheduled for adenotonsillectomy (T&A) received either caffeine benzoate, 20 mg/kg IV, (caffeine group, n = 36) or saline (placebo group, n = 36). The primary outcome evaluated the number of children who developed adverse post-extubation respiratory events, and the secondary outcome was the incidence of those events.


RESULTS
The results demonstrated the two groups differed in the number of children who developed adverse post-extubation respiratory events (p = 0.032). The overall incidence of adverse postoperative respiratory events was less in the caffeine group than the placebo group (p = 0.0196).


CONCLUSIONS
In children with OSA scheduled for T&A, administration of caffeine benzoate, 20 mg/kg IV, decreased the number of children who developed adverse post-extubation respiratory events and decreased the overall incidence of adverse post-extubation respiratory events. PACU duration, hospital discharge time and postoperative delirium did not differ between groups.
Khalil
Samia N
SN
Department of Anesthesiology, University of Texas Medical School, Houston, Texas 77030-1503, USA. Samia.N.Khalil@uth.tmc.edu
Maposa
Douglas
D
Ghelber
Oscar
O
Rabb
Mary F
MF
Matuszczak
Maria
M
Ganesan
Balamurugan A
BA
Tabrizi
Hessam Khalili
HK
Chuang
Alice Z
AZ
D002110:Caffeine / Q000008:administration & dosage / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement / Q000187:drug effects; D011183:Postoperative Complications / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D020181:Sleep Apnea, Obstructive / Q000188:drug therapy* / Q000209:etiology; D014068:Tonsillectomy; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D002110:Caffeine; D010100:Oxygen