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Author Block M Matangi, P Dutchak, U Jurt, D Brouillard

Kingston, Ontario

BACKGROUND: The lack of availability of Aminophylline for the routine reversal of Persantine during cardiac nuclear stress testing has necessitated the investigation of alternatives. Coffee is impractical. The effect of caffeine tablets is delayed due to slow absorption and energy drinks which are not pure caffeine seem unwise. There are cinnamon or spearmint flavoured caffeine buccal strips which deliver 40mg of caffeine. Buccal delivered caffeine is easily administered and rapidly absorbed. Buccal caffeine strips can be purchased at most local convenience stores.
METHODS: One-hundred and thirty-nine consecutive patients undergoing Persantine MIBI scanning were studied. All patients gave signed, informed consent. Persantine was infused over 4 minutes and 2 minutes later a dose of Sestamibi was injected. Three minutes later the buccal caffeine was administered. Synergy strips deliver 40mg of caffeine via the buccal route. The patients were monitored with ECG and BP in the normal manner. Aminophylline was administered intravenously only if clinically indicated in doses of 50mg to a maximum dose of 200mg. ANOVA was used to detect differences between the means of multiple groups and Tukey-Kramer intercomparisons testing was performed when appropriate. A p value of <0.05 was considered significant.
RESULTS: The mean age was 66.4 ± 10.8 years. Five of the 139 patients (3.7%) required Aminophylline to reverse the effects of the Persantine. There were no serious side effects observed from the buccal caffeine strips. The hemodynamic response to Persantine and the buccal caffeine is shown in Table 1. The heart rate and BP changes seen during Persantine administration are partially reversed by the buccal caffeine.
CONCLUSION: Buccal caffeine in a dose of 40mg is an acceptable alternative to intravenous Aminophylline for the routine reversal of Persantine. One still needs Aminophylline available for the small number of patients (3.7%) who do not respond to buccal caffeine. The cost per patient for buccal caffeine is 50 cents compared to $3.30 to $8.20 for intravenous Aminophylline depending on the dose administered.
Table 1. Hemodynamic response to persantine and buccal caffeine
  Number Rest Peak Recovery ANOVA
HR (bpm) 134 67.1 ±1 2.4 88.2 ± 13.8 78.5 ± 12.4 <0.0001
SBP (mmHg) 134 142.1 ± 20.0 128.7 ± 17.5 135.4 ± 17.3 <0.0001
HR = heart rate. SBP = systolic blood pressure.