Kardiovaskuläre Stressprotektion während der Anästhesieeinleitung

Abstract

Alpha-2-adrenoceptor-agonists as well as cardioselective betareceptor-antagonists have been shown to blunt stress response due to tracheal intubation. The purpose of our study was to investigate,whether clonidine or esmolol is more efficient to attenuate stress response due to intubation.44 patients were randomly assigned to receive either clonidine (n=22; 3 microg/kg) or esmolol (n=22; 2 mg/kg) immediately prior to a standardized induction of anaesthesia. Heart rate, arterial blood pressure, cardiac output, epinephrine and norepinephrine plasma concentrations were measured before,during and 10 min after intubation. Blood pressure was measured invasively and cardiac output was determined by transthoracic echocardiography. Absolute values and increase of mean arterial pressure and norepinephrine plasma concentrations were significantly less in the clonidine group (p<0,05). Clonidine (3 microg/kg) is more efficient than esmolol (2 mg/kg) in blunting stress response due to endotracheal intubation.

Comparative Study Between Intravenous Clonidine and Preservative Free Intravenous Lignocaine in Attenuation of Pressor Response to Laryngoscopy and Endotracheal Intubation

“…Oral clonidine (5 µg/kg) attenuated circulatory reactions to laryngoscopy and intubation, according to Batra et al, 19 oral clonidine does circumvent the response. The findings of this study are backed by earlier research by Ghignone et al 20 and Pouttu et al 21 When Zalunardo and Zollinger 22 compared intravenous clonidine (3 µg/kg i.v.) to intravenous esmolol (2 mg/kg i.v.)…”

A Prospective Randomized Study of Efficacy of Clonidine in Attenuating Haemodynamic Response to Laryngoscopy and Tracheal Intubation

“…clonidine at 1 min after intubation. Zalunardo MP et al Studied clonidine at a dose of 3 µg/kg noted that following Section: Anaesthesia laryngoscopy and intubation at 1 min HR increased by 23/min in control group and by only 6 /min in the clonidine pre-treated group and MAP rose by 37 mmHg in the control group and only 5 mmHg in the clonidine pre-treated group [6] . Altan A et al studied clonidine at a dose at 3 µg/kg noted that, following laryngoscopy and intubation, HR rose by 10 /min in the control group, whereas in the clonidine group, HR decreased by 10 /min, which is statistically highly significant (p<0.01) [7] .…”

Prämedikationsqualität und Patientenzufriedenheit nach Prämedikation mit Midazolam, Clonidin oder Placebo

“…Die pharmakologischen Vorteile liegen in der hohen oralen Bioverfügbarkeit, der schnellen Anschlagszeit und der verhältnismä-ßig kurzen Wirkzeit [1]. Daneben hat Clonidin verschiedene stress-und kardioprotektive Wirkungen: Präoperativ verabreichtes Clonidin senkt die Inzidenz von kardialen Komplikationen [33], reduziert den Anästhetikumbedarf [7,10] und vermindert die Stressreaktion bei der endotrachealen Intubation, bei Anlegen eines Pneumoperitoneums oder einer Tourniquetmanschette [16,34,35,36,37]. Zudem wird durch Prämedikation mit Clonidin das postoperative "shivering" signifikant vermindert [15,27].…”

“…Dabei bekommen im Extremfall ein junger kräftiger 20-jähriger Patient mit 90 kgKG 300 μg Clonidin und eine 75-jährige, schlanke Frau mit 50 kgKG die Hälfte, 150 μg Clonidin. Hierbei ist zu erwähnen, dass das gewählte Dosierungsschema nicht auf Voruntersuchungen im engeren Sinne basiert, sondern auf dem Prinzip des "educated guess" aus langjäh-riger klinischer Erfahrung und den Erfahrungen aus mehreren eigenen klinischen Studien mit Clonidin [34,35,36,37].…”