A new model to prevent or manage caffeine withdrawal after surgery

Millions of people consume caffeine in coffee, tea, sodas and energy drinks, but when they go without, the withdrawal symptoms can include drowsiness, difficulty concentrating and intense headaches. This can be a severe problem for surgery patients, who can't eat or drink anything for hours before their procedures (NPO status). As a result, caffeine withdrawal can cause major side effects, complicate treatment and extend hospital stays.

In a review published online on April 28 in the journal Food and Chemical Toxicology, Professor of Medicine Jeffrey Goldberger, M.D., and medical student Matthew Agritelley examined how caffeine addiction is currently handled and the steps clinicians can take to mitigate withdrawal symptoms. The review proposed a new model to better prevent or manage withdrawal, including caffeine supplementation, which could better control symptoms and improve recoveries.

We're very careful to take a drug or alcohol history to make sure people don't have to go cold turkey. But for caffeine, we don't do that at all. Nobody takes a caffeine history and the solution is so simple."

Jeffrey Goldberger, M.D., Professor of Medicine

Around 90 percent of adults use caffeine regularly and many become physically dependent. Withdrawal symptoms can begin as early as three hours after the ingesting caffeine and persist for as many as nine days.

Headaches, in particular, can complicate treatment and delay discharge. In addition, one study found that caffeine withdrawal increased the risk of delirium in intubated ICU patients. But the authors note that there is a major disconnect between the prevalence of caffeine addiction, the acuity of symptoms and how clinicians manage them.

In the review, the authors note that it would be relatively easy to provide caffeine supplements to prevent withdrawal. A number of studies have supported this approach.

Caffeine is currently used to treat apnea in premature babies and alleviate headaches in patients who receive spinal anesthesia. In other words, supplies are available to help surgery patients as well.

"There are many examples of caffeine supplementation in hospitals, either intravenously or orally, and it's clear that supplementation does prevent these problems," said Dr. Goldberger. "We have an easy solution to prevent these effects, but we don't have either the clinical awareness or the treatment mechanisms in place to get people what they need."

Dr. Goldberger believes more work needs to be done to better understand the problem and develop the necessary education and protocols to get caffeine to the patients who need it.

"This is a no-brainer," he said. "We have everything we need to supplement patients as needed and prevent these symptoms. But first we have to start paying better attention."

"There are many examples of caffeine supplementation in hospitals, either intravenously or orally, and it's clear that supplementation does prevent these problems," said Dr. Goldberger. "We have an easy solution to prevent these effects, but we don't have either the clinical awareness or the treatment mechanisms in place to get people what they need."

Dr. Goldberger believes more work needs to be done to better understand the problem and develop the necessary education and protocols to get caffeine to the patients who need it.

"This is a no-brainer," he said. "We have everything we need to supplement patients as needed and prevent these symptoms. But first we have to start paying better attention."