Effects of clonidine on breathing during sleep and susceptibility to central apnoea

Sankri-Tarbichi, Abdul Ghani; Grullon, K.; Badr, M. Safwan

doi:10.1016/j.resp.2012.09.005

Cited by 22 publications

(9 citation statements)

References 25 publications

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“…21 Clonidine enhances both sensory and motor block from epidural local anaesthetic. 22 At clinical doses it has minimal effects on hypercapnic and hypoxic ventilatory drive in adults [23][24][25][26] and children. 27 Cognitive impairment, difficulties with verbal communication, and the application of below-knee plasters did not allow accurate assessment of dermatomal spread of the epidural block.…”

Section: Discussionmentioning

confidence: 99%

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Chalkiadis

Sommerfield

Low

et al. 2015

Develop Med Child Neuro

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AUCArea under the curve SEMLS Single-event multilevel surgery AIM To compare diazepam use, muscle spasm, analgesia, and side effects when clonidine or fentanyl are added to epidural bupivacaine in children with cerebral palsy after multilevel orthopaedic surgery.METHOD Fifty children were prospectively randomized to receive clonidine (n=24, mean age 10y 10mo [SD 2y 11mo]) or fentanyl (n=26, mean age 10y 11mo [SD 2y 10mo]).RESULTS There was no difference in primary outcome measures: median diazepam use (fentanyl 0, interquartile range [IQR] 0-0; clonidine 0, IQR 0-0; p=0.46), any muscle spasm (no muscle spasms in: fentanyl, 36%; clonidine, 62%; p=0.11), painful muscle spasm (fentanyl 40%; clonidine 25%; p=0.46), or pain score ≥6 (none: fentanyl 44%; clonidine 42%; p=0.29). There were differences in secondary outcome measures: no vomiting (clonidine 63%; fentanyl 20%); vomiting occurred more frequently with fentanyl (32% vomited more than three times; clonidine none; p=0.001). Fentanyl resulted in more oxygen desaturation (at least two episodes: fentanyl 20%; clonidine 0; p<0.001). Clonidine resulted in lower mean (SD) area under the curve for systolic blood pressure (fentanyl 106.5 [11.0]; clonidine 95.7mmHg [7.9]) and heart rate (fentanyl 104.9 beats per minute [13.6]; clonidine 85.3 [11.5]; p<0.001).INTERPRETATION Clonidine and fentanyl provide adequate analgesia with low rates of muscle spasm, resulting in low diazepam use. The choice of epidural additive should be based upon the most tolerable side-effect profile.Cerebral palsy (CP) by definition is a disorder of movement and posture, caused by a non-progressive brain injury or lesion. 1 However, although the causative brain lesion is defined as a static encephalopathy, the musculoskeletal pathology in the limbs is progressive during the child's growth and maturation, with the development of contractures, bony torsion, and joint instability. Children with CP may undergo extensive orthopaedic surgery of the lower extremities to correct deformity and improve function. Single-event multilevel surgery (SEMLS), defined as at least one surgical procedure, performed on two different anatomical levels (hip, knee, or ankles), has been shown to result in dramatic improvements in gait and functioning, which are sustained at 5-year follow-up and reduce the need for serial surgeries and periods of rehabilitation. 2,3 Good pain control is important for patient comfort and facilitates early rehabilitation and discharge. Effective pain management is challenging because of multiple surgical incisions, associated comorbidities (chronic lung disease, risk of aspiration, epilepsy, gastro-oesophageal reflux), and impairments in communication and/or cognition that may make pain assessment difficult. In addition, the surgical nociceptive input is likely to lead to wind-up of spinal reflexes and worsening of muscle spasm 4 and possibly to an escalating pain-spasm cycle. Epidural analgesia is the preferred modality of regional anaesthesia in our institution but there are limited data...

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Section: Discussionmentioning

confidence: 99%

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Chalkiadis

Sommerfield

Low

et al. 2015

Develop Med Child Neuro

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show abstract

“…A single report describes a potential role for clonidine as adjunctive therapy for hypocapnic central sleep apnea syndromes [182]. In a study of 10 healthy subjects (4 females) (age 22.3 ± 3.0 years; BMI 25.5 ± 3.4 kg/m 2 ), subjects were randomized to receive placebo or 0.1 mg/45 kg of clonidine on 2 separate nights.…”

Section: Clonidinementioning

confidence: 99%

Nocturnal Non-Invasive Ventilation

Basner

Parthasarathy²

2015

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“…51 In a study of 10 healthy subjects (4 females) (age 22.3 +/− 3.0 years; BMI 25.5 +/− 3.4 kg/m 2 ), subjects were randomized to receive placebo or 0.1 mg/45 kg of clonidine on 2 separate nights. Ventilation and upper airway resistance were monitored during wakefulness and sleep.…”

Section: Non-positive Airway Pressure Treatments For Central Sleep Apmentioning

confidence: 99%

Alternative Approaches to Treatment of Central Sleep Apnea

Thomas

2014

Sleep Medicine Clinics

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Synopsis Divergent approaches to treatment of hypocapnic central sleep apnea syndromes reflect the difficulties in taming a hyperactive respiratory chemoreflex. As both sleep fragmentation and a narrow CO2 reserve or increased loop gain drive the disease, sedatives (to induce longer periods of stable non-rapid eye movement (NREM) sleep and reduce the destabilizing effects of arousals in NREM sleep) and CO2-based stabilization approaches are logical. Adaptive ventilation reduces mean hyperventilation yet can induce ventilator-patient dyssynchrony, while enhanced expiratory rebreathing space (EERS, dead space during positive pressure therapy) and CO2 manipulation directly stabilize respiratory control by moving CO2 above the apnea threshold. Carbonic anhydrase inhibition can provide further adjunctive benefits. Provent and Winx may be less likely to trigger central apneas or periodic breathing in those with a narrow CO2 reserve. An oral appliance can meaningfully reduce positive pressure requirements and thus enable treatment of complex apnea. Novel pharmacological approaches may target mediators of carotid body glomus cell excitation, such as the balance between gas neurotransmitters. In complex apnea patients, single mode therapy is not always successful, and multi-modality therapy might need to be considered. Phenotyping of sleep apnea beyond conventional scoring approaches is the key to optimal management.

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Effects of clonidine on breathing during sleep and susceptibility to central apnoea

Cited by 22 publications

References 25 publications

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Nocturnal Non-Invasive Ventilation

Alternative Approaches to Treatment of Central Sleep Apnea

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