Reduced Narcotic Requirement by Clonidine with Improved Hemodynamic and Adrenergic Stability in Patients Undergoing Coronary Bypass Surgery

Flacke, Joan W.; Bloor, B. C.; Flacke, Werner; D, Wong; Dazza, Stephen J.; Stead, Stanley W.; Laks, Hillel

doi:10.1097/00000542-198707000-00003

Cited by 418 publications

(100 citation statements)

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“…47 Recently, clonidine has been utilized as a preoperative medication providing anxiolysis, 12,48 sedation, 49 analgesia, 11,50,51 hemodynamic stability, 13,50-53 saliva control, 23,54 and antiemetic effects. 55 It also possesses sedative-, 56,57 anesthetic-, 58,59 and analgesic-sparing 13,53 properties. Clonidine exhibits anxiolytic effects independent of sedation 60 and also reduces perioperative plasma catecholamine 53 and prolactin 61 concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…55 It also possesses sedative-, 56,57 anesthetic-, 58,59 and analgesic-sparing 13,53 properties. Clonidine exhibits anxiolytic effects independent of sedation 60 and also reduces perioperative plasma catecholamine 53 and prolactin 61 concentrations. Optimal oral premedication dosage has been established at 0.2 mg for an average 70-kg adult.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are confirmed and reinforced by a large body of literature. 12, 13,15,[49][50][51][52][53][55][56][57][58]67,69,70 Clonidine is a mixed alpha agonist drug possessing peripheral ␣1 and ␣2 activity as well as imidazoline agonist effects. In low doses it primarily produces central ␣2 effects.…”

Section: Discussionmentioning

confidence: 99%

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Oral Clonidine Pretreatment Prior to Venous Cannulation

Hall

Rezvan

Tatakis

et al. 2006

Anesthesia Progress

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Clonidine is a preferential alpha-2 agonist drug that has been used for over 35 years to treat hypertension. Recently, it has also been used as a preoperative medication and as a sedative/anxiolytic drug. This randomized, double-blind, placebo-controlled crossover clinical trial characterized the effects of oral clonidine pretreatment on intravenous catheter placement in 13 patients. Parameters measured included the bispectral index (BIS), Observer's Assessment of Alertness/Sedation Scale (OAA/S), frontal temporal electromyogram (EMG), 30-Second Blink Count (Blink), Digit Symbol Substitution Test (DSST), State Anxiety Inventory (SAI), fingertip versus forearm skin temperatures, and multiple questionnaires. Oral clonidine significantly decreased SAI scores, OAA/S, EMG, and Blink, but did not cause statistically significant BIS or DSST reductions. Subjects preferred oral clonidine pretreatment prior to venipuncture compared to placebo. Questionnaires also indicated that clonidine provided minimal sedation, considerable anxiolysis, and some analgesia. Fingertip versus forearm skin temperature differentials were decreased. Reduced fingertip versus forearm temperature differentials suggest increased peripheral cutaneous blood flow prior to venous cannulation. Oral clonidine pretreatment not only helped control patient anxiety and pain but also provided cardiovascular stability.Key Words: Clonidine; Venous cannulation; BIS; SAI; DSST.I ntravenous (IV) catheters have become the accepted standard of care for general anesthesia and IV sedation. 1 Catheterization of peripheral veins can be made more comfortable using a variety of techniques, including local anesthesia infiltration, 2,3 nitrous oxide inhalation, 2,4,5 ethyl chloride topical, 4,6 eutectic mixture of local anesthetics (lidocaine-prilocaine) cream, 7,8 tetracaine patches, 9 and even midazolam nasal spray. 10 The goals of these methods are pain and anxiety reduction with minimal invasiveness and lack of significant complications. An additional benefit of some cannulation pretreatments is cutaneous vasodilation.Previous medical anesthesia/sedation studies have indicated that clonidine administration prior to surgery decreases pain 11,12 and anxiety 12 and also stabilizes blood pressure and heart rate by reduction of central sympathetic outflow. [13][14][15] Additional investigations have shown that clonidine pretreatment also increases skin temperature 16 and decreases the difference between fingertip and forearm temperatures. 17 These results suggest an increase in cutaneous blood flow. 18 The purpose of this randomized, double-blind, placebo-controlled crossover clinical trial was to characterize the sedative/anxiolytic effects and changes in skin temperatures of oral clonidine pretreatment prior to IV catheter placement. METHODSThe study protocol and informed consent form were approved by The Ohio State University Institutional Review Board. Inclusion criteria were (a) adults with American Society of Anesthesiologists ASA1 or ASA2 health status, (b) severe ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Oral Clonidine Pretreatment Prior to Venous Cannulation

Hall

Rezvan

Tatakis

et al. 2006

Anesthesia Progress

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“…At the same time, the requirement for anaesthetic and opioid administration is reduced. [5][6][7][8][9] Before general recommendations about the usefulness of clonidine preanaesthetic medication can be established, more clinical studies are required which examine the effects of clonidine in different patient populations and different surgical settings. 1o As maintenance of haemodynamic stability and avoidance of hypertensive episodes is important in patients with intracranial pathology, ~ clonidine might be a useful adjunct to general anaesthesia for neurosurgery.…”

Section: Cette Dtude Fut Conduite Afin D'examiner Les Effets Hdmodynamentioning

confidence: 99%

Cardiovascular and endocrine effects of clonidine premedication in neurosurgical patients

et al. 1991

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“…(7,8) Intravenous doses of 2.5mcg/kg-5mcg/kg have been used in the perioperative period to reduce stress response to intubation, hyper adrenergic & hyperdynamic responses to prolonged tourniquet use in orthopedic surgeries and in the reduction of intraoperative bleeding. (9,10) Clonidine attenuates sympathetically mediated hyperdynamic responses, making it a useful adjunct in patients at risk for myocardial ischemia.…”

mentioning

confidence: 99%

Effect of Premedication With Intravenous Clonidine on Haemodynamic Changes in Laparoscopic Cholecystectomy: A Randomised Study

Sudheer¹,

Gunasekaran²,

Sahajananda³

et al. 2015

jemds

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BACKGROUND: Laparoscopic cholecystectomy offers many benefits but significant hemodynamic changes are observed, which can be detrimental especially in elderly and hemodynamically compromised patients. Clonidine was found to inhibit the release of catecholamines and vasopressin and thus modulate the haemodynamic changes induced by pneumoperitoneum. AIM AND OBJECTIVES OF THE STUDY: To assess the efficacy of intravenous clonidine premedication in prevention of adverse haemodynamic changes during laparoscopic cholecystectomy. The following parameters were studied. Heart rate and Blood pressure response to induction, intubation and pneumoperitoneum. Requirements of intra-op analgesia like Fentanyl. Incidence of post-op nausea and vomiting Incidence of shivering. METHODS: 100 patients undergoing elective laparoscopic cholecystectomy were randomly assigned to one of the two groups to receive either clonidine 4 micrograms per kg or equivalent quantity of normal saline The primary outcome was to assess the efficacy of intravenous clonidine premedication in prevention of adverse haemodynamic changes during laparoscopic cholecystectomy. STATISTICAL METHODS: Student t test (two tailed, independent) has been used to find the significance of study parameters (HR, SBP, DBP) on continuous scale between two groups (Inter group analysis) and to test the homogeneity samples based on age (continuous parameters). Chi-square test was used to test the homogeneity of samples based on parameters on categorical scale between two groups. P<0.05 was considered as statistically significant. The statistical software namely SPSS 15.0, Stata 8.0, Med Calc 9.0.1 and Systat 11.0 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. RESULTS: The result showed that Blood Pressure (SBP, DBP, MAP) and HR in study group fell significantly to lower level within 10 minutes after starting clonidine infusion and remained significantly low during laryngoscopy and intubation, pneumoperitoneum and extubation (P<0.001). CONCLUSION: Premedication with 4μg/kg body weight of intravenous clonidine has been found to be safe and effective method that provides stable hemodynamics and protection against stress response triggered by pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. It also brings down the incidence of post-operative complications such as nausea, vomiting and shivering

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Reduced Narcotic Requirement by Clonidine with Improved Hemodynamic and Adrenergic Stability in Patients Undergoing Coronary Bypass Surgery

Cited by 418 publications

References 0 publications

Oral Clonidine Pretreatment Prior to Venous Cannulation

Oral Clonidine Pretreatment Prior to Venous Cannulation

Cardiovascular and endocrine effects of clonidine premedication in neurosurgical patients

Effect of Premedication With Intravenous Clonidine on Haemodynamic Changes in Laparoscopic Cholecystectomy: A Randomised Study

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