Clonidina/Clonidine

Estudio sobre clonidina como premedicación y sus efectos hemodinámicos perioperatorios en pacientes normotensos


A study on clonidine as a premedicant and its effects on perioperative hemodynamic in normotensive patients.
Singh N R, Rajkumar G, Singh S S, Jamatia P, Singh T H, Singh T.
J Med Soc [serial online] 2012 [cited 2013 Jun 10];26:180-3.
Abstract
Background: Hemodynamic instability is one of the most imminent conditions during general anesthesia (GA), especially, during laryngoscopy and intubation. The aim of the study was to study the perioperative hemodynamic effect of clonidine in normotensive patients undergoing elective surgery under GA. Materials and Methods: A randomized double blinded placebo controlled study was conducted in the department of Anesthesiology, Regional Institute of Medical Sciences, Imphal on 150 normotensive adult patients of either sex aged 18-60 years (American Society of Anesthesiologist I and II) undergoing elective surgery under GA. The patients were allocated into three groups viz.: Group 1-2 μg/kg clonidine; group II-3 μg/kg clonidine; and group III - placebo/normal saline. The test drug was administered 30 min before the induction of anesthesia. Upon arrival at theatre, the following data were recorded viz.: (1) Visual analogue score of anxiety, (2) loss of consciousness, and (3) dryness of mouth. Pre-induction heart rate (HR) and blood pressure (BP) were recorded 5 min after resting on the operating table. HR and BP were recorded during the time of intubation every 8 min and ½ h after intubation during the intraoperative period (post-intubation). Postoperative BP and HR on arrival at the post-anesthetic care unit and then every ½ h for 3 h were recorded. Any episodes of nausea and vomiting, shivering and analgesic requirements were noted. Results: Clonidine 2 μg/kg and 3 μg/kg both significantly controlled the perioperative hemodynamics. The hemodynamic changes were statistically significant at all times intervals except at preoperative, at 8 min post-intubation to 1 h post-intubation period. Conclusion: Clonidine is useful as a premedicant in controlling the perioperative hemodynamics changes in normotensive patients undergoing operative procedures under GA.
Keywords: Clonidine, General anesthesia, Hemodynamics, Premedicant

http://www.jmedsoc.org/text.asp?2012/26/3/180/113244





Disminución de la respuesta presora a la laringoscopía directa e intubación traqueal: clonidina oral vs. gabapentina en la premedicación

Attenuation of the pressor response to direct laryngoscopy and tracheal Intubation: oral clonidine vs. oral gabapentin premedication.
Montazeri K, Kashefi P, Honarmand A, Safavi M, Hirmanpour A.
Associate Professor of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2011 Mar;16 Suppl 1:S377-86.
Abstract
BACKGROUND: We carried out this study to compare the efficacy of oral gabapentin and clonidine premedication for controlling the pressor responses to laryngoscopy and tracheal intubation. METHODS: In this double-blind clinical trial, ninety-six patients were randomly allocated to one of three groups according to the agents to be used before the induction of anaesthesia: Group P (n = 32) received oral placebo, Group G (n = 32) received 800 mg of gabapentin, and Group C (n = 32) received 0.3 mg of clonidine 90 minutes prior to surgery. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR) and rate pressure product (RPP) were measured at baseline (3 min before induction), just before laryngoscopy, and postintubation (at 1, 3, 5, 10 and 15 min after starting laryngoscopy). Statistical analysis of data was done with repeated measure ANOVA and chi-square test. RESULTS: HR and RPP significantly decreased in Group G and Group C at 5, 10, and 15 minutes after tracheal intubation compared with those just before laryngoscopy (p < 0.05). No significant difference was noted between Group G and Group C considering these variables. SAP, DAP, MAP and RPP at 1, 3, 5, 10, and 15 minutes after intubation were significantly lower in Group G compared with Group P (p < 0.05). There was no significant difference between Group C and Group P in this regard. CONCLUSIONS: The present study demonstrated that premedication with oral gabapentin 800 mg or clonidine 0.3 mg similarly blunted the hyperdynamic response after laryngoscopy and intubation.
KEYWORDS: Premedication, intubation, laryngoscopy, oral clonidine, oral gabapentin, pressor response
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252769/?report=classic



Respuesta hemodinámica durante la colecistectomía laparoscópica: Efecto de dos dosis diferentes de clonidina intravenosa en la premedicación


Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication.
Tripathi DC, Shah KS, Dubey SR, Doshi SM, Raval PV.
Department of Anaesthesiology, Government Medical College, Bhavnagar, Gujarat, India.
J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):475-80. doi: 10.4103/0970-9185.86586.
Abstract
BACKGROUND: Clonidine has emerged as an attractive premedication desirable in laparoscopic surgery wherein significant hemodynamic stress response is seen. The minimum safe and effective dose of intravenous clonidine to attenuate the hemodynamic stress response during laparoscopic surgery has however not yet been determined. MATERIALS AND METHODS: This prospective, randomized, double-blind controlled study was conducted on 90 adults of ASA physical status I and II, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized to one of the three groups (n= 30). Group I received 100 ml of normal saline, while groups II and III received 1 μg/ kg and 2 μg/ kg of clonidine respectively, intravenous, in 100 ml of normal saline along. All patients received glycopyrrolate 0.004 mg/kg and tramadol 1.5 mg/kg intravenously, 30 min before induction. Hemodynamic variables (heart rate, systolic, diastolic, mean arterial pressure), SpO2, and sedation score were recorded at specific timings. MAP above 20% from baseline was considered significant and treated with nitroglycerine. RESULTS: In group I, there was a significant increase in hemodynamic variables during intubation pneumoperitoneum and extubation (P<0.001). Clonidine given 1 μg/kg intravenous attenuated hemodynamic stress response to pneumoperitoneum (P<0.05), but not that associated with intubation and extubation. Clonidine 2 μg/kg intravenous prevented hemodynamic stress response to pneumoperitoneum and that associated with intubation and extubation (P<0.05). As against 14 and 2 patients in groups I and II respectively, no patient required nitroglycerine infusion in group III. CONCLUSIONS: Clonidine, 2 μg/ kg intravenously, 30 min before induction is safe and effective in preventing the hemodynamic stress response during laparoscopic cholecystectomy.



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214551/





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Anestesiología y Medicina del Dolor
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