Effect of intravenous clonidine premedication for the bloodless surgical field in patients undergoing middle ear or nasal surgery: A comparison of three different doses

Ramchandani, Sarita; Lakra, Anand Masih; Shah, Pratibha Jain; Lalwani, Jaya; Sahare, Kamal Kishore

doi:10.4103/0259-1162.161821

Cited by 7 publications

(10 citation statements)

References 11 publications

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“…[8][9][10][11][12][13] Moreover, it attenuates stress-induced sympathoadrenal responses to painful stimuli, improves the intraoperative hemodynamic stability, reduces the incidence of perioperative myocardial ischemic episodes in patients with suspected or documented coronary artery disease, and decreases anesthetic requirements during surgery. [14][15][16][17][18] Dexmedetomidine is a highly selective α2 agonist. Systemic administration of dexmedetomidine has been a focus of interest for their sedative, analgesic, sympatholytic and cardiovascular stabilizing effect with reduced anesthetic requirement.…”

Section: Discussionmentioning

confidence: 99%

“…It also reduces the requirement of isoflurane, fentanyl, and metoprolol for controlled hypotension. 24 Pandazi et al studied about low dose clonidine premedication and hypotension after carotid artery surgery and concluded intravenous premedication with lowdose clonidine (1 μg/Kg) was found to be effective in preventing hypertensive episodes during carotid endarterectomy under general anaesthesia but seemed to increase the incidence of hypotension postoperatively. 25 Peden C J et al studied the effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil and found dexmedetomidine caused a reduction in the overall concentration and dose of propofol required.…”

Section: Discussionmentioning

confidence: 99%

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An Observational Study for Comparison of Perioperative Effects of Intravenous Clonidine and Dexmedetomidine as Premedication for General Anaesthesia for Thyroidectomy Patients

M¹,

K.A²

2020

jebmh

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BACKGROUND Sympathetic system overactivity can result from direct laryngoscopy and intubation in general anaesthesia. This is often associated with tachycardia, hypertension, and arrhythmias and can rarely result in ischemia in susceptible individuals. Similar hemodynamic effects can result from surgical stimulation also. Deep plane of anaesthesia, intravenous opioids, beta blockers, lignocaine, dexmedetomidine, clonidine, alpha blockers, etc. are different techniques used to prevent this. There are many studies comparing various techniques but similar studies for comparing equal doses (1 mcg/Kg) of intravenous clonidine and dexmedetomidine are few. METHODS After obtaining institutional ethical committee clearance, a prospective observational study among 66 ASA class I and II patients was conducted and distributed among two groups with 33 in each, undergoing thyroidectomy under general anaesthesia. Patients were enrolled into two groups. The clonidine group received 1 mcg/Kg intravenous clonidine and the dexmedetomidine group 1 mcg/Kg intravenous dexmedetomidine as an infusion over 15 minutes before induction of general anaesthesia. The hemodynamic response to direct laryngoscopy and intubation, surgical incision and extubation as measured by the change in heart rate and blood pressure which were monitored in the perioperative period. At the end, duration of analgesia defined as the time of start of induction of general anaesthesia to the time of first request for rescue analgesic, or VAS (Visual Analogue Scale)= 40 mm were documented. The incidence of side effects, such as hypotension, bradycardia, were also monitored. All statistical analyses were carried out using the software Statistical Package for the Social Sciences (SPSS) Statistics version 19.0.0 with the help of a professional statistician. Data was expressed in its frequency and percentage as well as mean and standard deviation. RESULTS Analysis of the monitored data shows that patients in the dexmedetomidine group had more stable hemodynamic effects to direct laryngoscopy, intubation and surgical incision. The duration of analgesia of both the clonidine and dexmedetomidine were similar and did not show any significant statistical difference. Both the groups of patients had few cases of side effects like hypotension and bradycardia which were neither clinically nor statistically significant and these were easily remediable. CONCLUSIONS Use of dexmedetomidine is preferred to clonidine as intravenous premedication at 1 mcg/Kg dose.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An Observational Study for Comparison of Perioperative Effects of Intravenous Clonidine and Dexmedetomidine as Premedication for General Anaesthesia for Thyroidectomy Patients

M¹,

K.A²

2020

jebmh

View full text Add to dashboard Cite

show abstract

“…had produced satisfactory and reliable hypotension in patients undergoing middle ear and nasal surgeries. 2 Studies have compared three doses of intravenous clonidine. 2 mics/kg, 3 mics/kg B.W, 5 mics/kg B.W.…”

Section: Discussionmentioning

confidence: 99%

“…1 By inducing hypotension, bleeding from surgical field can be reduced thereby providing a clear surgical field. 2 Clonidine is drug which is well known for its hypotensive property within good safety profile.…”

Section: Introductionmentioning

confidence: 99%

Clonidine Premedication as a Desirable Part of Hypotensive Anaesthesia for Functional Endoscopic Sinus Surgery

Praveen¹,

R²

2016

jemds

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BACKGROUNDClonidine an ideal agent for hypotensive anaesthesia, also attenuates stress response to laryngoscopy, decreases requirement of inhalational anaesthetic agents, decreases postoperative analgesic requirements, prevents post-operative shivering. MATERIAL AND METHODS60 patients under 16-60 years age group posted for functional endoscopic sinus surgery (FESS) were randomly divided into 2 groups of 30 each. Placebo group (Group P) received 20 mL normal saline intravenously and Clonidine group (Group C) received 2.5 micrograms Clonidine per kilogram body weight in 20 mL saline intravenously 20 mins before surgery. Haemodynamic variability during surgery, intraoperative inhalational agent requirement and perioperative bleeding as assessed by surgeon, postoperative analgesic requirement and post-operative shivering were compared between two groups. RESULTSThere was statistically significant reduction in heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure in Group C compared to Group P. There was statistically significant decrease in requirement of Isoflurane, decreased bleeding from surgical site, decreased analgesic consumption and nil incidence of postoperative shivering in Group C compared to Group P. CONCLUSIONClonidine is an ideal agent for hypotensive anaesthesia as it has got other favourable effects along with controlled hypotension, as it was observed in this study.

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“…Deliberate hypotension is a procedure used to minimize intraoperative bleeding and enhance the consistency of the surgical field for improved vision during middle ear surgery and other head and neck surgeries [1] . However, regulated hypotension is needed for middle ear surgery to achieve a bloodless surgical field [2] .…”

Section: Introductionmentioning

confidence: 99%

Magnesium sulfate versus nitroglycerin in controlled hypotensive anesthesia in middle ear surgeries

El-Din

Madian

Salem

et al. 2020

International Journal of Medical Arts

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Background: Controlled hypotension is required for middle ear surgeries to achieve a bloodless operative field and improve its quality, both magnesium sulfate and nitroglycerine used to produce deliberate hypotension. Aim of the work: This study aimed to compare the efficacy of magnesium sulfate and nitroglycerin in inducing controlled hypotensive anesthesia as a primary outcome and using propranolol if tachycardia occurred as a secondary outcome, in middle ear surgeries. Patients and Methods: The study was carried out on 40 adults' patients were randomly classified into two equal groups, twenty patients each: Group [M]: Received an intravenous [IV] bolus of magnesium sulfate 30 mg/ kg in 100 ml saline over 10 min followed by infusion of 10 mg/kg/h. Group [N]: Received nitroglycerin IV infusion 0.5-10 mcg/kg/min. Propranolol 1-2.5 mg IV had been given to both groups if there was tachycardia. Results: Both drugs induced hypotension with statistically significant difference in systolic and mean blood pressure [BP] and there was highly significant increase in heart rate [HR] in nitroglycerin more than magnesium sulfate and high doses of propranolol were administrated in nitroglycerine group. Postoperative pain was significantly increased in nitroglycerin than magnesium sulfate groups which had more analgesic effect. Conclusion: Both drugs induced hypotension. However, magnesium sulfate was better as it provided optimum surgical field, less tachycardia, need less dose of propranolol with less post-operative pain in comparison to nitroglycerin.

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Effect of intravenous clonidine premedication for the bloodless surgical field in patients undergoing middle ear or nasal surgery: A comparison of three different doses

Cited by 7 publications

References 11 publications

An Observational Study for Comparison of Perioperative Effects of Intravenous Clonidine and Dexmedetomidine as Premedication for General Anaesthesia for Thyroidectomy Patients

An Observational Study for Comparison of Perioperative Effects of Intravenous Clonidine and Dexmedetomidine as Premedication for General Anaesthesia for Thyroidectomy Patients

Clonidine Premedication as a Desirable Part of Hypotensive Anaesthesia for Functional Endoscopic Sinus Surgery

Magnesium sulfate versus nitroglycerin in controlled hypotensive anesthesia in middle ear surgeries

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