A comparison of effects of oral premedication with clonidine and metoprolol on intraoperative hemodynamics and surgical conditions during functional endoscopic sinus surgery (original) (raw)
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Effects of clonidine premedication on hemodynamic changes
Purpose: Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The pneumoperitoneum used for laparoscopic procedures leads to significant impairment of cardiopulmonary function. Methods: This randomized double blind study started with institute ethics committee approval. Sixty ASA 1 and ASA 2 patients undergoing elective laparoscopic cholecystectomy with no cardiovascular co-morbidity were enrolled for the study and received either tab clonidine 150 mcg [group C-30] or placebo drug tab lorazepam 2mg [group L-30] orally one hour before the induction. Heart rate, systolic blood pressure, diastolic pressure and mean arterial pressure were recorded. The data obtained was analyzed using student's-test, ANOVA and Chi-square test. Results: There is significant reduction of heart rate (16.6003), systolic pressure (22.433) and mean arterial pressure (14.8) (p<0.001) in study group. Conclusion: From our study we found that oral clonidine 150mcg can effectively counteract the cardiovascular changes induced by pneumoperitoneum.
IOSR Journals , 2019
Objectives: Clonidine is a centrally acting sympatholytic agent with antihypertensive activity. It blunts stress response, provides analgesia, sedation and augments effects of anesthesia. Hence it was hypothesized to be an ideal agent to prevent stress response associated with laparoscopic surgeries and provide post-operative analgesia. Patients and Methods: 120 adult patients of ASA physical status I and II scheduled to undergo elective laparoscopic cholecystectomy under general anesthesia were randomly allocated to receive oral clonidine (150 mcg) premedication (Group I, n=60) or placebo (Group II, n=60) 90 mins prior to induction. Intra-operatively they were managed by standard anesthetic agents. The two groups were compared in terms of hemodynamic parameters, sevoflurane concentrations at predetermined intervals during surgery, post-operative time to analgesic request and cumulative analgesic requirements. Results: Mean heart rate, blood pressure and sevoflurane concentration requirements at 1 and 5 mins after intubation, skin incision, start of pneumoperitoneum, 15 and 30 mins after pneumoperitoneum and 15 mins after release of pneumoperitoneum were significantly lower in clonidine group than in placebo group. Time to request of analgesic in clonidine group (150.72 ± 38.47) was significantly higher than that in placebo group(128 ± 28.5 minutes), (p= 0.0004). Total post-operative tramadol requirement in excess of 2 doses was only in 15% of patients in clonidine group vs 60% of patients in placebo group. Conclusions: Administration of oral clonidine premedication resulted in better hemodynamic stability and reduction of intra-operative anesthetic requirement and post-operative analgesia.
British Journal of Anaesthesia, 2005
Background. Pre-medication with clonidine reduces the requirement for volatile agents during general anaesthesia. This may also be true for anaesthesia with propofol, but the amount of dose reduction has not been measured. Because clonidine also affects cardiac output and thus regional blood flow it could alter the pharmacokinetics of propofol. This randomized, doubleblind placebo-controlled trial aimed to study the effect of clonidine pre-medication on dose requirement for propofol during lower extremity vascular surgery using the bispectral index (BIS) as a measure of anaesthetic depth. Methods. After oral pre-medication with either clonidine 3 mg kg À1 or placebo, 39 subjects had lower limb vascular surgery using propofol infusion for anaesthesia. Anaesthetic depth was adjusted to a BIS of 45. Predicted plasma propofol concentrations were noted every 30 min from a target-controlled propofol infusion pump and arterial samples were taken at the same time for propofol measurements. Results. Patients in both groups were anaesthetized to similar depths of anaesthesia as indicated by BIS readings (P=0.44). The groups had comparable mean (95% CI) arterial concentrations of propofol, 4.8 (3.5-6.1) mg ml À1 in the patients given clonidine, and 4.6 (3.4-5.7) mg ml À1 in the patients given placebo (P=0.81). However, the average plasma concentration predicted by the target-controlled infusion was less in the clonidine group [3.2 (2.9-3.5)] than in the group given placebo [3.6 (3.3-3.9)] mg ml À1 (P<0.05). Conclusions. Pre-medication with clonidine reduces the requirement for propofol, which is a pharmacokinetic effect and not a pharmacodynamic central sedative effect.
2019
Background: Laparoscopic surgery is associated with significant hemodynamic and pathophysiological changes due to creation of pneumoperitoneum. Clonidine is known to inhibit catecholamine and vasopressin release during pneumoperitoneum. This randomized, double-blinded, controlled study was conducted to evaluate the effect of administration of intravenous clonidine for the control of hemodynamic responses during the laparoscopic surgery and also to evaluate requirement of propofol during laparoscopic surgery. Methodology: 60 patients undergoing elective laparoscopic cholecystectomy were randomized into Group-C (clonidine group) and GroupS (saline group). In clonidine group patients received 3µg/kg of clonidine diluted in 10 ml saline over 10 minutes, while in saline group patients received 10 ml saline. Induction of anesthesia was same in both groups. Heart rate, systolic, diastolic blood pressure and mean arterial pressure were measured before premedication, before induction, after intubation, before CO 2 insufflation, after insufflation and then subsequently at 15 min interval till desufflation and after extubation. Propofol requirement was calculated in both groups. Statistical Analysis: Unpaired 'T' test was used to compare both groups. Decision of applying unpaired t-test was based on normality test (Shapiro-Wilk). Results: Heart rate, systolic, diastolic and mean arterial blood pressures were significantly less in clonidine group as compared to control group. Intraoperatively there was significant heart rate variation in control group 82.93 ± 6.53/min to 96.13 ± 6.80/min than in clonidine group 86.30 ± 9.12/min to 73.13 ± 8.51/min (P<0.001). Mean blood pressure varied from 94.51 ± 4.82 mmHg to 102.18 ± 5.56 mmHg in control group while in clonidine group it varied from 94.14 ± 7.82 mmHg to 72.62 ± 1.87 mmHg. (P<0.001). Propofol requirement was significantly less in clonidine group. Conclusion: Administration of clonidine attenuates hemodynamic response to pneumoperitoneum and reduces the requirement of propofol.
Journal of Clinical Anesthesia, 1995
Study Objective': Determine the hemodynamic consequences of intraoperative clonidine during major abdominal surgery. Design: Prospective open trial. Setting: Teaching hospital. Patients: 402 consecutive patients scheduled for major abdominal surgery. Interventions: 350 consecutive patients received intravenous (IV) clonidine (loading dose of 4 p.glkg in 20 minutes at anesthesia induction, followed by a continuous infmion of 2 p.glkglh until the end of surgery). Fifty-two additional patients served as controls. Anesthetic technique consisted of balanced anesthesia (isoflurane, fentanyl, atracurium). ECG, invasive arterial blood pressure (BP), expiratory PCO, and pulse oximetry were continuously recorded. Hemodynamic events {HEs) were defined as moderate for a 20% reduction of the baseline systolic blood pressure (SBP) or a heart rate (HR) decreasing between 50 beats per minute (bpm) and 40 bpm. A 30% reduction of the baseline SBP or a HR below 40 bpm was considered an important HE. The rate and duration of these events were recorded from induction to recovery. HEs requiring a specific treatment were noted. Central venous pressure, volume of fluid infused, and urinary output were also recorded. Measurements and Main Results: 21% of control patients and 31% of clonidine patients had no adverse HEs. A moderate reduction of the baseline BP was the most common episode in both groups. The incidence of the HEs (moderate and important) was similar in both groups but the duration HEs was signaficantly longer in the clonidine patients (p < 0.05). 4OYo of the control patients and 13% of the clonidine patients required specific management for their HEs (p < 0.05), the most common of which was hypotension without bradycardia. Neither coexisting pathology nor preoperative medications influenced the incidence of HEs. Conclusion: IV clonidine can be used routinely during anesthesia for major abdominal surgery.
Low-Dose (1 g/kg) Clonidine Premedication and Hypotension After Carotid Artery Surgery
Vascular and Endovascular Surgery, 2011
We investigated the role of low-dose clonidine intravenous (IV) premedication in arterial pressure variation during and after carotid endarterectomy (CEA). A total of 84 patients, American Society of Anesthesiologists (ASA) II-III, scheduled for elective CEA under general anesthesia participated in this study. The patients were divided into 2 groups: group P (n ¼ 42) and group C (n ¼ 42) and received N/S 0.9% (placebo) or clonidine 1 mg/kg IV, respectively, 15 minutes before induction of anesthesia. Recovery times, number of patients needed to be treated for circulatory events (hypertension, hypotension, and bradycardia), number of circulatory events per patient, and consumption of vasoactive drugs (nitroglycerine, phenylphrine, and atropine) intraoperatively and the first 6 hours postoperatively were recorded. Significantly less hypertensive episodes were observed intraoperatively, but more hypotensive episodes were observed postoperatively in patients receiving clonidine. Intravenous premedication with lowdose clonidine (1 mg/kg) seems to be effective in preventing hypertensive episodes during CEA under general anesthesia but seems to increase the incidence of hypotension postoperatively.
Anesthesia and Analgesia, 1994
We studied 61 patients undergoing elective major noncardiac surgery in a randomized, double-blind, placebo-control clinical trial to test the hypothesis that the addition of clonidine to a standardized general anesthetic could safely provide postoperative sympatholysis for patients with known or suspected coronary artery disease. Patients were allocated randomly to receive either placebo (n = 31) or clonidine (n = 30). The treatment group received prernedication with a transdermal clonidine system (0.2 mg/d) the night prior to surgery, which was left in place for 72 h, and 0.3 mg oral clonidine 60-90 min before surgery. Clonidine reduced enflurane requirements, intraoperative tachycardia, and myocardial ischemia (1/28 clonidine patients vs 5/24 placebo, P = 0.05). However, clonidine decreased heart rates only during the first five postoperative hours; the incidence of postoperative myocardial ubstantial morbidity, mortality, and costs are associated with coronary artery disease (CAD) in S elderly surgical patients, particularly in those who have vascular surgery (1 ). Electrocardiogram (ECG) monitoring has been used to document that patients with CAD are more likely to manifest myocardial ischemia after surgery rather than before surgery (2). Clonidine is an a,-adrenergic agonist with the potential to improve outcome in high-risk patients undergoing noncardiac surgery (3,4).
PubMed, 2000
Background: To investigate the clinical efficacy of oral clonidine premedication in anesthesia and analgesia in patients undergoing laparoscopic cholecystectomy (LC). Methods: One hundred and ten patients, scheduled for elective laparoscopic cholecystectomy, were recruited for the prospective, randomized, single-blind, comparative study. They were randomly allotted to either of the placebo or clonidine group. Patients of the placebo group (n = 65) were premedicated with oral antacid (alugel hydroxide 300 mg), while those in the clonidine group (n = 45) were premedicated with oral clonidine 150 micrograms prior to anesthesia. The premedication was given 60 to 90 min before the anticipated time of induction of anesthesia. Normocapnia was maintained throughout the perioperative period. Mass spectrometer was used to assess the inspired and expiratory concentrations of isoflurane, the anesthetic used for maintenance of anesthesia. Postoperative pain intensity, sedation scores, adverse events, time to the first dose of postoperative analgesic and cumulative analgesic requirement in 24 hours were recorded. Data were expressed as mean +/- SD. Results: Patients in the clonidine group displayed greater hemodynamic stability perioperatively and the isoflurane requirement was also reduced (30% less). The postoperative analgesic requirement was less (1.5 +/- 1.3 vs. 2.2 +/- 1.3 dose, P < 0.05) and the time for the first dose of analgesic was prolonged (411 +/- 565 vs. 264 +/- 441 min) in comparison with the placebo group but no statistic difference was found. Conclusions: Oral clonidine premedication helped to provide perioperative hemodynamic stability, spared the use of isoflurane and reduced the requirement of postoperative analgesia so as to smoother the way to recovery in patients undergoing LC.