Caffeine Withdrawal Headaches After Anesthesia

Many anesthesiologists do not allow patients to drink coffee 2-3 hours prior to anesthesia stating that it is not a clear liquid. The question posed is dairy free coffee or tea a clear liquid allowed prior to anesthesia and why bother when they can have water? In our practice, black coffee and tea as well as caffeinated energy beverages and colas are considered clear liquids. We allow patients who have high daily intakes of caffeine to drink black coffee or other clear caffeinated beverages 3 hours before anesthesia to prevent the onset of postoperative headache.

Caffeine withdrawal is also in adolescents and children. The incidence in teens and children may increase substantially with the growing market for highly caffeinated, easily accessible beverages.

Postoperative caffeine withdrawal headaches are not uncommon and can result in delayed discharged alone with discomfort to a healthy outpatient. Perhaps preoperative instructions should say liquids without particulate matter. Consider plain Gelatin (Jell-O®) which contains protein. We do not allow gelatin products for children within 6 hours of anesthesia as we do not allow breast milk (protein). A one-ounce serving of unflavored gelatin has 30 calories and seven grams of protein.

Caffeine Withdrawal Headaches in Adults and Children:

1. Symptomatic caffeine withdrawal can be common perioperatively when patients are requested to withhold food and drink.
2. Onset of initial symptoms can present as early as 3 hours from abstinence.
3. Caffeine withdrawal has been well-characterized by headache, fatigue, decreased energy and alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability, fogginess or not clearheaded.
4. Caffeine withdrawal is also in adolescents and children. The incidence in teens and children may increase substantially with the growing market for highly caffeinated, easily accessible beverages.

Research on Caffeine Withdrawal Headaches

• A study review in 2000 demonstrated that patients drinking clear liquids until two hours before surgery actually had emptier stomachs during the procedure.  Lately, research shows that sonographic volume assessment can determine if the volume present is consistent with baseline gastric secretions and negligible risk (up to 1.5 ml kg−1).
• Fennelly et al. hypothesized that caffeine withdrawal was a mechanism of postoperative headache. Their study’s logistic regression analysis noted that “for each 100 mg increase in caffeine consumption, there was a 16% increase in the odds of postoperative headache developing (p<0.0001). Symptoms typically present within 12-24 hours.
• Weber et al. performed a randomized controlled, double-blind trial with 300 adult ambulatory surgical patients and found that those who received prophylactic administration of 200 mg caffeine intravenously were less likely to have postoperative headache than patients who received placebo – 10% versus 2% (p<0.05).  Prophylactic intravenous administration of caffeine and recovery after ambulatory surgical procedures. Weber JG1, Klindworth JT, Arnold JJ, Danielson DR, Ereth MH.

Conclussion:

We allow patients who have high daily intakes of caffeine to drink black coffee or other clear caffeinated beverages 3 hours before anesthesia to prevent the onset of postoperative headache.

What kind of fluids are patients allowed to consume before surgery?

Clear liquids—something you can see through.

Liquids which are ALLOWED:

• Clear Broth (Fat- free)
• Clear soups
• Popsicle’s without fruit pulp or pieces of fruit
• Juices without pulp (Apple and white cranberry)
• Lemonade without pulp
• Sport Drinks (Gatorade)
• Clear sodas (Regular and not diet drinks such as Sprite, Pepsi, Coke & Lemonade)
• Tea and Coffee (No milk or cream)
• Nutritional Drinks (Enlive, Ensure Clear)