Premedication with oral clonidine decreases intraoperative bleeding and provides hemodynamic stability in cesarean section

Abstract

Background: Intentional lowering of blood pressure helps to produce a desirably clean surgical field. Many drugs can be used to induce a hypotensive state, but due to their high potency and rapid effect, drugs that more easily and safely control the induction of hypotension are desirable. Objectives: To investigate the effects of premedication with oral clonidine on intraoperative bleeding and hemodynamic variables in patients undergoing cesarean sections. Patients and Methods: A total of 110 patients classified as American Society of Anesthesiologists (ASA) physical status I and II and who were scheduled for elective cesarean section under general anesthesia were enrolled. The patients were randomized to receive either oral clonidine (0.2 mg) or identical-looking placebo tablets 90 minutes before arriving at the operating room. Induction of anesthesia was performed by the same standard protocol in all patients. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were recorded before and after induction; immediately after intubation; 5, 10, and 15 minutes thereafter; at the time of extubation; and one hour after the operation. The surgeons were asked to rate the quality of the operative field on a four-point scale that ranged from mild (1) to abundant bleeding (2). Results: Intraoperative SBP was lower in the clonidine group. After both intubation and extubation, the increases in SBP, DBP, and HR in clonidine-treated subjects were significantly less than the changes in the control patients. The amount of fentanyl given to control blood pressure and HR was significantly less in the clonidine group (18 ± 38 vs. 39 ± 53 μg, P = 0.02). The responses to the four-point scale indicated that intraoperative bleeding in the clonidine group was less than in the placebo group (1.2 ± 0.4 vs. 1.7 ± 0.6, P < 0.05). Conclusions: Premedication with oral clonidine can improve the hemodynamic management of cesarean cases.

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

“…So prior to laryngoscopy, additional pharmacological measures like use of volatile anaesthetics, topical and intravenous lidocaine, opioids, vasodilators-SNP, NTG, Calcium channel blockers and β-blockers have been tried but none was found ideal. [3,4] Clonidine, a central α-2 agonist has sedative, analgesic and antihypertensive actions. [5] Hence, there is a need to study the effects of intravenous clonidine for attenuation of hemodynamic stress response to laryngoscopy and intubation.…”

Comparison of Surgical Conditions During Propofol or Isoflurane Anesthesia for Endoscopic Sinus Surgery

“…The general idea in many studies is based on that general anesthesia with propofol provides better vision of surgical field and less amount of hemorrhage during the operation compared to Isoflurane or Sevoflurane ( 5 ). A group of studies suggest that premedication with oral clonidine decreases intraoperative bleeding in some surgeries ( 6 , 7 ). Metoprolol has shown to decrease bleeding in nasal sinuses ( 8 ).…”

Spinal versus general anaesthesia in percutaneous nephrolithotomy

“…Among these advantages of SA, decreasing blood loss is a main issue of SA in PCNL surgery. Recent studies investigated the effects of a 200-μg of oral clonidine tablet 60 -90 minutes before anaesthesia, which reduced blood loss significantly in several kinds of surgeries under GA that could be a future choice along with SA in PCNL [24,25] Tetzlaff et al have also shown that in spinal surgeries, SA was a better choice for anaesthesia compared to GA resulting in lower side effects [26].…”