Clonidine as an adjunctive medication for local anaesthesia in oral and maxillofacial surgery

Mutzbauer, Till S.; Obwegeser, Joachim A.; Grätz, K W

doi:10.1016/s0901-5027(05)80994-4

Cited by 1 publication

(5 citation statements)

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“…Additionally, titration of clonidine is challenging because of the risk of inducing hypotension in the initiation phase and the imposed risk of reflexive hypertension in the discontinuation phase. 8,20 It is worth mentioning that 70% of patients in the clonidine group in our study had received dexmedetomidine compared to 38% in the non-clonidine group, which can impact the results when considering dexmedetomidine withdrawal. 21,22 These outcomes might cause clinicians to have clonidine reserved for refractory PSH cases that may not respond properly to beta-blockers alone.…”

Section: Discussionmentioning

confidence: 94%

“…21,22 These outcomes might cause clinicians to have clonidine reserved for refractory PSH cases that may not respond properly to beta-blockers alone. 8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Patients in the non-clonidine groups received less IV opioids compared to the clonidine group, which can be related to the baseline risk. This can be further explored to assess the analgesic impact of clonidine in patients with TBI.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,6 Clonidine works as an alpha-2 agonist in the brainstem. 8 This leads to a reduction of the sympathetic outflow. 8 The most relevant safety concern with clonidine use is symptomatic sinus bradycardia and hypotension.…”

Section: Introductionmentioning

confidence: 99%

“…8 This leads to a reduction of the sympathetic outflow. 8 The most relevant safety concern with clonidine use is symptomatic sinus bradycardia and hypotension. 9 The reduction of autonomic dysregulation and sympathetic outflow were associated with mortality reduction among patients with TBI when BBs were used.…”

Section: Introductionmentioning

confidence: 99%

“…This reduction is desirable to help mitigate sympathetic surges in patients with TBI. 1,2,8 However, limited data exist to support the use of clonidine following TBI, and guidelines make no specific recommendation regarding clonidine use. 2,[12][13][14] Therefore, the aim of this study was to evaluate the safety and effectiveness of enteral clonidine use among adult patients with TBI with agitated behavior.…”

Section: Introductionmentioning

confidence: 99%

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Clonidine safety and effectiveness in the management of suspected paroxysmal sympathetic hyperactivity post-traumatic brain injury: A retrospective cohort study

Alshaya,

Aldhaeefi,

Alodhaiyan

et al. 2023

Science Progress

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Introduction: Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. In addition, TBI may cause paroxysmal sympathetic hyperactivity (PSH), which is associated with poor clinical outcomes. This study aimed to evaluate the safety and effectiveness of clonidine in patients with TBI and suspected PSH. Methods: A retrospective cohort study for critically ill patients with TBI with suspected PSH admitted to intensive care units (ICUs) from 1 May 2016 to 31 January 2020 at a tertiary academic medical center. Eligible patients were categorized based on clonidine use during their ICU stay (Clonidine group vs. Control group). The primary outcome was the improvement in functional outcomes during ICU stay, defined by a delta Glasgow Coma Score (GCS). Secondary outcomes included ICU and hospital length of stay, heart rate variation, and 90-day mortality. Results: A total of 2915 patients were screened, of which 169 were included. Based on multiple regression analysis, patients who received clonidine showed better improvement in functional outcomes by a higher mean delta GCS than patients who did not (Beta Coeff. 0.41; CI: 0.07 – 0.74; P = 0.02). In addition, the patient's GCS upon ICU discharge and IV opioids requirement on day three were higher in the clonidine group than control (beta coefficient (95% CI): 0.18 (0.03, 0.32); p = 0.02 and beta coefficient (95% CI): 1.38 (0.24, 2.52); p = 0.02, respectively). No statistical differences were observed in any of the other secondary outcomes after adjusting for confounders. Conclusion: This study found that patients who received clonidine had better functional outcomes during their ICU stay, as shown by their delta GCS than those who did not. Other outcomes were similar between the groups. More data are needed to explore the role of clonidine in patients with TBI with suspected PSH.

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Section: Discussionmentioning

confidence: 94%