Effect of oral clonidine premedication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients

Howie, Michael B.; Hiestand, D C; Jopling, Michael; Romanelli, V A; Kelly, William B.; McSweeney, Thomas D.

doi:10.1016/0952-8180(96)00033-5

Cited by 26 publications

(16 citation statements)

References 15 publications

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“…There is increasing evidence that sympathetic nervous system mediated cardiovascular stimulation with increased catecholamine blood levels is the principal mechanism responsible for perioperative tachycardia and hypertension, myocardial ischemia and infarction [1-3]. Even short-lived changes may have detrimental effects on the coronary circulation of high-risk patients, with higher rates of morbidity and lethality [4,5].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing preoperative stress response in coronary artery bypass graft patients

et al. 2004

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BackgroundIn many studies investigating measures to attenuate the hemodynamic and humoral stress response during induction of anaesthesia, primary attention was paid to the period of endotracheal intubation since it has been shown that even short-lasting sympathetic cardiovascular stimulation may have detrimental effects on patients with coronary artery disease. The aim of this analysis was, however, to identify the influencing factors on high catecholamine levels before induction of anaesthesia.MethodsVarious potential risk factors that could impact the humoral stress response before induction of anaesthesia were recorded in 84 males undergoing coronary aortic bypass surgery, and were entered into a stepwise linear regression analysis. The plasma level of norepinephrine measured immediately after radial artery canulation was chosen as a surrogate marker for the humoral stress response, and it was used as the dependent variable in the regression model. Accordingly, the mean arterial blood pressure, heart rate and the calculated pressure-rate product were taken as parameters of the hemodynamic situation.ResultsStepwise regression analysis revealed that the oral administration of low-dose clonidine (mean dose 1.75 μg·kg-1) on the morning of surgery was the only significant predictor (p = 0.004) of the high variation in preoperative norepinephrine plasma levels. This intervention decreased norepinephrine levels by more than 40% compared to no clonidine administration, from 1.26 to 0.75 nmol·l-1. There was no evidence for dose-responsiveness of clonidine. All other potential predictors were removed from the model as insignificant (p > 0.05). The use of beta-blocker, ace-inhibitors, ejection fraction, and body mass index were significant determinants for the hemodynamic situation (heart rate, mean arterial pressure, pressure rate product) of the patient during the pre-induction period.ConclusionThe oral administration of clonidine is the only significant predictor for the observed variation of norepinephrine levels during the preoperative period. Lack of significant dose responsiveness suggests that even a low dose of the drug can attenuate the preoperative stress response and thus is recommended in cardiovascular high risk patients.

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Section: Introductionmentioning

confidence: 99%

Factors influencing preoperative stress response in coronary artery bypass graft patients

et al. 2004

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“…8,9 In the clinical setting, preanesthetic clonidine reduces the requirement of volatile anesthetics and/or opioid. 4 Recently, we reported that preanesthetic oral clonidine (150 lag) relieved anxiety and reduced the dose of propofol required for minor surgery. 1~ These properties might affect the depth of anesthesia and, consequently, reduce the dose of PGE1 required to produce hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…4 In animal studies, intravenous co-administration of clonidine reduces the dose of vasodilator required to induce hypotension, s These findings imply that preanesthetic administration of clonidine is a useful adjuvant for deliberate hypotension. This study was designed to investigate the effect of orally administered clonidine on the dose of PGE1 required to produce hypotension during radical hysterectomy.…”

mentioning

confidence: 95%

Oral clonidine reduces the requirement of prostaglandin El for induced hypotension

Murakami

Mammoto

Imai

et al. 1999

Can J Anesth/J Can Anesth

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Oral clonidine reduces the requirement of prostaglandin E1 for induced hypotensionPurpose: To determine the effects of preanesthetic oral clonidine on the dose of prostaglandin EI (PGEI) required to produce hypotension during anesthesia. Method: Oral placebo, 75/.tg or 150/./g donidine were administered 60 min prior to induction of anesthesia. Anesthesia was maintained with O~ : N20 (30:70) and isoflurane 1.0 %. After hemodynamic stabilization, an infusion of prostaglandin E I was started (0.05 ~g'kg -t 'min -I) and the rate of infusion was adjusted to maintain mean arterial pressure (MAP) between 60-70 mmHg during operation. Results: Duration of hypotension in placebo, 75/.tg and 150/.tg preanesthetic oral clonidine treated groups were 132 _+ 46, 117 • 37 and 129 _ 56 min, respectively. The PGE I requirement in each group were 1563 _ 180 (28.6 _ 3.2), 594 _+ 197 (I 0.8 _+ 3.6) and 283 +_ 30 (5.5 _ 3.6) pg ~g-kg-I), respectively. In addition, blood loss in each group were 1461 __ 389, 805 -+ 240 and 931 _+ 40 ml, respectively. Conclusion: Preanesthetic oral clonidine decreased the dose of PGEI required to produce hypotension, and decreased the blood loss during operation.Objectif: D6terminer les effets de I'administration pr&nesth6sique de clonidine orale sur la dose de prostaglandine E I (PGE I) n6cessaire ~ la production d'hypotension pendant I'anesth6sie. M&hode : Un placebo oral, 75/.tg ou 150 ~g de clonidine ont 6t6 administr6s 60 min avant I'induction de I'anesth&ie. I'anesth&ie a 6t6 maintenue avec un m61ange 02 : N20 (30:70) et de I'isoflurane ~ 1,0 %. Apr& la stabilisation des param~tres h6modynamiques, on a commenc6 la perfusion de prostaglandine EI (0,05 /.tg'kg -~ -min -j) et le d6bit de la perfusion a 6t6 ajust6 pour conserver la tension art6rielle moyenne (TAM) entre 60-70 mmHg pendant I'intervention. RK~ultats : La dur6e de I'hypotension avec le placebo ou 75/Jg ou 150/.tg de clonidine pr~anesth&ique orale a &6 de 132 __+ 46, I 17 _+ 37 et de 129 _+ 56 min, respectivement. Les besoins de PGE I dans chaque groupe ont 6t~ de 1563 _ 180(28,6 _ 3,2), 594 _ 197(10,8 _ 3,6) et de 283 _ 30(5,5 ___ 3,6)~g (flg.kg-I), respectivement. De plus, la perte sanguine dans chaque groupe a 6t6 de 1461 _ 389, 805 __-240 et de 931 +_ 40 ml, respectivement. Conclusion : Ladministration pr6anesth&ique de clonidine diminue la dose de PGEI n6cessaire ~ la production d'hypotension et r6duit la perte sanguine pendant I'op6ration.

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“…Bu grupta kullanıma giren ilk ajan olan klonidinin İKH'da perioperatif prognozu olumlu etkilediği gös-terilmiştir (12)(13)(14)(15) . Nisbeten daha yeni bir α2-agonist olan deks koroner cerrahisinde, entübasyona hemodinamik yanıtın kontrolündeki etkisi araştırılmıştır (5) .…”

Section: Analjezik Gereksinimiunclassified

Effects of Dexmedetomidine Sedation on Myocardial Ischemia in Peripheral Vascular Surgery Performed Under Epidural Anaesthesia

Kavlak¹,

Ulke²,

Sungur³

et al. 2013

GKDA Derg

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Effect of oral clonidine premedication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients

Cited by 26 publications

References 15 publications

Factors influencing preoperative stress response in coronary artery bypass graft patients

Factors influencing preoperative stress response in coronary artery bypass graft patients

Oral clonidine reduces the requirement of prostaglandin El for induced hypotension

Effects of Dexmedetomidine Sedation on Myocardial Ischemia in Peripheral Vascular Surgery Performed Under Epidural Anaesthesia

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