• David Lagier, Laetitia Nee, Régis Guieu, François Kerbaul, Emmanuel Fenouillet, Nicolas Roux, Roch Giorgi, Alexis Theron, Dominique Grisoli, Vlad Gariboldi, Frederic Collart, Nicolas Bruder, Lionel Velly, and Catherine Guidon.
• From the Department of Anaesthesia and Intensive Care Medicine (DL, LN, FK, NB, LV, CG), Department of Biochemistry (RG, EF), Department of Biostatistics (NR, RG), Department of Cardiac Surgery (AT, DG, VG), La Timone University Hospital, Aix-Marseille University, Marseille, France (FC).
• Eur J Anaesthesiol. 2018 Dec 1; 35 (12): 911-918.

BackgroundRaised plasma levels of endogenous adenosine after cardiac surgery using cardiopulmonary bypass (CPB) have been related to the incidence of postoperative atrial fibrillation (POAF).ObjectiveWe wished to assess if caffeine, an adenosine receptor antagonist could have a beneficial effect on the incidence of POAF.DesignA randomised controlled study.SettingSingle University Hospital.PatientsOne hundred and ten patients scheduled for heart valve surgery with CPB.InterventionsWe randomly assigned patients to receive peri-operative oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma concentrations and caffeine pharmacokinetic profile were evaluated in a subgroup of 50 patients.Main Outcome MeasuresThe primary endpoint was the rate of atrial fibrillation during postoperative hospital stay.ResultsThe current study was stopped for futility by the data monitoring board after an interim analysis. The incidence of atrial fibrillation was similar in the caffeine and in the placebo group during hospital stay (33 vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P = 0.60). Basal and postoperative adenosine plasma levels were significantly associated with the primary outcome. Adenosine plasma levels were similar in the two treatment groups. Caffeine administration was associated with a higher incidence of postoperative nausea and vomiting (27 vs. 7%, P = 0.005).ConclusionOral caffeine does not prevent POAF after heart valve surgery with CPB but increased the incidence of postoperative nausea and vomiting.Clinical Trial RegistrationClinicalTrials.gov, no.: NCT01999829.

30 keywords...

hide…