Clonidine Premedication in Patients with Sleep Apnea Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study

Abstract

Patients with sleep apnea often present with cardiac diseases and breathing difficulties, with a high risk of postoperative respiratory depression. We conducted a randomized, double-blind, prospective study in 30 adult patients with obstructive sleep apnea, undergoing elective ear-nose-throat surgery. The patients were randomly assigned to receive placebo or clonidine (2 microg/kg oral) the night before and the next morning 2 h before surgery. Spo2, heart rate, mean arterial blood pressure, snoring, and oronasal airflow were monitored for 36 h. A standard anesthesia was used consisting of propofol and remifentanil. Anesthetic drug consumption, postoperative analgesics, and pain score were recorded. In the clonidine group, mean arterial blood pressures were significantly lower during induction, operation, and emergence from anesthesia. Both propofol dose required for induction (190 +/- 32.2 mg) and anesthesia (6.3 +/- 1.3 mg . kg(-1).h(-1)) during surgery were significantly reduced in the clonidine group compared with the placebo group (induction 218 +/- 32.4, anesthesia 7.70 +/- 1.5; P < 0.05). Piritramide consumption (7.4 +/- 5.1 versus 14.2 +/- 8.5 mg; P < 0.05) and analgesia scores were significantly reduced in the clonidine group. Apnea and desaturation index were not different between the groups, whereas the minimal postoperative oxygen saturation on the day of surgery was significantly lower in the placebo than in the clonidine group (76.7% +/- 8.0% versus 82.4% +/- 5.8%; P < 0.05). We conclude that oral clonidine premedication stabilizes hemodynamic variables during induction, maintenance, and emergence from anesthesia and reduces the amount of intraoperative anesthetics and postoperative opioids without deterioration of ventilation.

Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity

“…At 1, 2, and 4 h, clonidine did not significantly decrease pain intensity. At 1 h, the median of the average VAS pain scores in control subjects was 3.6 cm (range, 2.8 -5.0), 32,33,37,38,41 at 2 h it was 3.3 cm (range, 1.8 -5.0), 21,33,38 and at 4 h, it was 4.6 cm (range, 1.0 -4.6). 21,31,33 At 12 and 24 h, clonidine significantly decreased pain intensity.…”

“…Data on pain scores at different postoperative time points were reported in 14 trials. 15,17,18,21,23,29 -33,37-39,41 Ten trials tested clonidine, 17,18,21,29,[31][32][33]37,38,41 and data on VAS pain scores at 1, 2, 4, 12, 24, or 48 h after the end of surgery could be combined ( fig. 3; see Supplemental Digital Content 1, http://links.lww.com/ALN/A847, figs.…”

“…In only one trial, 32 rectal diclofenac was administered systematically in all patients after induction. The limited number of relevant trials did not allow performing sensitivity analyses to test whether the concomitant usage of nonsteroidal antiinflammatory drugs had any impact on the analgesic efficacy of ␣2 agonists.…”

Perioperative management of the severely obese patient: a selective pathophysiological review

“…There are a number of options for adjunctive therapy to reduce analgesic requirements, with positive studies using preoperative central a-2 receptor agonists (e.g., clonidine and dexmedetomidine), pregabalin and gabapentin, and combined clonidine and S-ketamine. [125][126][127][128] If opioid-based patient-controlled analgesia is to be used, background infusions should be avoided, and the lockout period should be adjusted to minimize sedation and respiratory depression.…”

Anesthesia for the surgical procedures of the morbidly obese

“…[36] Alpha 2 agonists like clonidine and dexmedetomidine have also been used to diminish opioid use, as well as antiemetics, and shorten PACU stay. [37][38][39][40] Some ongoing studies propose the use of ketamine and antiepileptics like pregabaline and gabapentine. Pain control through an epidural catheter may also be proposed, any antiaggregant drug use should be taken into consideration.…”