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; Wong, D.; Dazza, Stephen J.; Stead, Stanley W.; Laks, Hillel

doi:10.1097/00132586-198802000-00019

Cited by 34 publications

(68 citation statements)

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“…In addition to its sedative, anxiolytic, analgesic and antihypertensive properties [6,22] it has shown to improve congestive heart failure, to optimize the myocardial oxygen supply / demand ratio in ischemic heart disease [23,24] and to reduce attacks of angina pectoris [25,26]. …”

Section: Discussionmentioning

confidence: 99%

“…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]. Thus, many studies have concentrated on the stressful stimulus of endotracheal intubation, and a number of pharmacological attempts have been used to attenuate the hemodynamic response, including the use of high doses of opioids, α 2 -adrenergic receptor agonists, β-adrenergic blocking drugs or other antihypertensive drugs [3,4,6-19]. …”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors influencing preoperative stress response in coronary artery bypass graft patients

et al. 2004

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“…[15,16] It also reduces the need for anesthetics [15,17,18] and, therefore, can be used as an adjunct to general During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment.…”

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confidence: 99%

Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG

et al. 2010

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During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 microg/kg) before the anesthesia induction. Heart rate (HR) and blood pressure (BP) were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX) group systolic (SAP), diastolic (DAP) and mean arterial pressures (MAP) were lower at all times in comparison to baseline values; in the placebo (PLA) group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

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“…Ghignone et al [5] showed a 45% reduction in requirements for analgesics during the intraoperative period after clonidine premedication compared to standard premedication in patients undergoing bypass surgery. Flacke et al [18] demonstrated reduced sufentanil requirement by 40% while improving hemodynamic profile during coronary artery bypass graft as well. Interestingly Frank et al [19], similarly to our investigation, demonstrated a reduction in cumulative remifentanil dose by 24% after clonidine premedication in patients undergoing maxillofacial surgery under TIVA.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clonidine and Midazolam Premedication Before Endoscopic Sinus Surgery: Results of Clinical Trial

Wawrzyniak

Kusza

Cywiński

2014

Clin Exp Otorhinolaryngol

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ObjectivesPremedication with clonidine has been found to reduce the bleeding during endoscopic sinus surgery (ESS), therefore lowering the risk of surgical complications. Premedication is an essential part of pre-surgical care and can potentially affect magnitude of systemic stress response to a surgical procedure. The aim of this study was to compare the efficacy of premedication with clonidine and midazolam in patients undergoing sinus surgery.MethodsForty-four patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or midazolam as a premedication before receiving propofol/remifentanil total intravenous anesthesia. The effect of this premedication choice on anesthetic requirements, intraoperative hemodynamic profile, preoperative anxiety and sedation as well as postoperative pain and shivering were examined in each premedication group.ResultsTotal intraoperative remifentanil requirement was lower in the clonidine group as compared to the midazolam group 503.2±147.0 µg vs. 784.5±283.8 µg, respectively (P<0.001). There was no difference between groups in required induction dose of propofol, level of preoperative anxiety, level of sedation and postoperative shivering. Intraoperative systemic blood pressure and heart rate response had a more favorable profile in patients premedicated with clonidine. Postoperative pain assessed by visual analogue scale for pain was lower in the clonidine group compared with to the midazolam premedication group.ConclusionPremedication with clonidine provides better attenuation of hemodynamic response and reduction of intraoperative remifentanil requirements in patients undergoing ESS. Postoperative pain seems to be better controlled after clonidine premedication as well.

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

Cited by 34 publications

References 0 publications

Factors influencing preoperative stress response in coronary artery bypass graft patients

Factors influencing preoperative stress response in coronary artery bypass graft patients

Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG

Comparison of Clonidine and Midazolam Premedication Before Endoscopic Sinus Surgery: Results of Clinical Trial

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