The effects of aminophylline on bispectral index during inhalational and total intravenous anaesthesia*

Abstract

Summary Aminophylline is usually used during anaesthesia to treat bronchospasm but recent findings suggest that it can also be used to shorten recovery time after general anaesthesia. However, it is unclear whether aminophylline shows similar properties during a steady‐state phase of deep surgical anaesthesia. We therefore wanted to test the hypothesis that the administration of aminophylline leads to an increase in bispectral index as a surrogate parameter suggesting a lighter plane of anaesthesia. The study was designed as a double‐blind, randomised, controlled trial with two main groups (aminophylline and placebo) and two subgroups (sevoflurane and propofol). We studied 60 patients. The injection of aminophylline 3 mg.kg−1 was associated with significant increases in bispectral index up to 10 min after its injection, while heart rate and blood pressure did not change. It appears that aminophylline has the ability to partially antagonise the sedative effects of general anaesthetics.

A Comparison of the Effects of Low and High Doses of Aminophylline on Recovery Time and the Bispectral Index Score Following Iso flurane Anesthesia

“…Hupfl demonstrated the effects of aminophylline on the bispectral index during inhalational and total intravenous anesthesia and reported that it was associated with a significant increase in the BIS up to 10 minutes following the aminophylline injection (20).…”

“…Escalating doses of aminophylline have been used in many studies; El Tahan administered 2, 3, 4, and 5 mg/kg of aminophylline after sevoflurane and total intravenous anesthesia, which accelerated the patients' postoperative cognitive recovery, induced higher respiratory rate values and lower sedation scores, and shortened the times to eye opening, extubation, achievement of an Aldrete score ≥ 9, and PACU discharge after ambulatory surgeries (20,24,25). The type of operation in many of these trials was a non-laparotomy procedure with a short duration, which raised a major question: In our study, why did aminophylline increase the recovery period after laparotomies that used isoflurane anesthesia?…”

Effects of aminophylline on cognitive recovery after sevoflurane anesthesia

“…In the present study, escalating doses of aminophylline both significantly increased the entropy values and shortened the recovery times. Similarly, several other studies reported higher Bispectral Index values and faster recovery after intravenous aminophylline administration [6][7][8][9]19].…”

“…Studies over the last 20 years have shown that aminophylline significantly improves the clinical recovery from sevoflurane anesthesia [6,7]. However, this agent is still not used on a widespread basis.…”

“…Aminophylline at 2-5 mg/kg accelerates the recovery from sevoflurane anesthesia [6][7][8][9] through increased ventilatory elimination of sevoflurane and its action as an adenosine monophosphate-dependent phosphodiesterase inhibitor [10]; however, this may be associated with increases in heart rate (HR) [6][7][8][9]. The increase in the elimination of sevoflurane by aminophylline shortens the recovery, as it is known that aminophylline increases diaphragmatic contractility, minute ventilation, tidal volume and respiratory frequency [11].…”