Use of therapeutic caffeine in acute care postoperative and critical care settings: a scoping review

Abstract

Background Caffeine is the most utilised psychoactive drug worldwide. However, caffeine withdrawal and the therapeutic use of caffeine in intensive care and in the perioperative period have not been well summarised. Our objective was to conduct a scoping review of caffeine withdrawal and use in the intensive care unit (ICU) and postoperative patients. Methods PubMed, Embase, CINAHL Complete, Scopus and Web of Science were systematically searched for studies investigating the effects of caffeine withdrawal or administration in ICU patients and in the perioperative period. Areas of recent systematic review such as pain or post-dural puncture headache were not included in this review. Studies were limited to adults. Results Of 2268 articles screened, 26 were included and grouped into two themes of caffeine use in in the perioperative period and in the ICU. Caffeine withdrawal in the postoperative period increases the incidence of headache, which can be effectively treated prophylactically with perioperative caffeine. There were no studies investigating caffeine withdrawal or effect on sleep wake cycles, daytime somnolence, or delirium in the intensive care setting. Administration of caffeine results in faster emergence from sedation and anaesthesia, particularly in individuals who are at high risk of post-extubation complications. There has only been one study investigating caffeine administration to facilitate post-anaesthetic emergence in ICU. Caffeine administration appears to be safe in moderate doses in the perioperative period and in the intensive care setting. Conclusions Although caffeine is widely used, there is a paucity of studies investigating withdrawal or therapeutic effects in patients admitted to ICU and further novel studies are a priority.

The role of caffeine in headache disorders

“…There are specific situations in which caffeine withdrawal occurs commonly, including the postoperative and ICU setting [26 ▪ ], fasting for Ramadan [27 ▪ ], and early pregnancy [28 ▪ ]. In the hospital setting, caffeine withdrawal syndrome (including headache) may adversely influence recovery from illness, prompting some to recommend caffeine supplementation for appropriate individuals [29]. A small randomized controlled study in migraine patients found that abrupt withdrawal from caffeine is a potent trigger for migraine [30], with severe attacks reported in seven of nine individuals who withdrew from caffeine and none when the same individuals continued caffeine.…”

Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature

“…Of the seven prospective studies evaluating the effects of caffeine withdrawal, five studies showed that caffeine withdrawal increased the incidence of postoperative headache. Three studies have investigated the administration of caffeine for the relief of postoperative headache, including two prospective randomized controlled trials that concluded that the administration of caffeine prophylaxis reduces the incidence of postoperative headache [ 76 ].…”