Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery

Abstract

Purpose. The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery. Methods. 2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages). Results. Patients receiving clonidine (n = 193) were younger (66 (57–73) vs 70 (63–77) years, p=0.003) and had a lower SAPS II (35 (27–48) vs 41 (31–54), p=0.008) compared with patients receiving dexmedetomidine (n = 141). At the start of the drug infusion, HR (90 (75–100) vs 90 (80–105) bpm, p=0.028), MAP (70 (65–80) vs 70 (65–75) mmHg, p=0.093), and norepinephrine (0.05 (0.00–0.11) vs 0.12 (0.03–0.19) mcg/kg/min, p<0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR < 60 bpm) developed in 7.8% with clonidine and 5.7% with dexmedetomidine (p=0.51). Between baseline and 12 hours, norepinephrine remained stable in the clonidine group (0.00 (−0.04–0.02) mcg/kg/min) and decreased in the dexmedetomidine group (−0.03 (−0.10–0.02) mcg/kg/min, p=0.007). Conclusions. Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.

Comparison of Efficacy Between Dexmedetomidine and Propofol After Coronary Artery Bypass Graft Surgery

“…Patients who receive dexmedetomidine may undergo a more gradual recovery from anaesthesia, leading to enhanced cognitive results. (18) We conducted our study on 80 patients randomised in two equal groups. Group A received DEX, while Group B received propofol.…”

Alpha-2-adrenergic receptor agonists for the prevention of delirium and cognitive decline after open heart surgery (ALPHA2PREVENT): protocol for a multicentre randomised controlled trial

“…There is a shortage of studies comparing intravenous dexmedetomidine and intravenous clonidine in ICU or postoperative settings. 74 To our knowledge, a widely agreed evidence-based intravenous dosage regimen has not been developed for intravenous clonidine. A study by Grest et al in critically ill patients after cardiac surgery 74 and a recent meta-analysis favour equipotency mg per mg. 75 Thus, our choice is fairly pragmatic, but the doses are similar to that currently used in many ICUs as part of routine practice.…”

“…We will dose the drug considerably lower, to avoid side effects. There is a shortage of studies comparing intravenous dexmedetomidine and intravenous clonidine in ICU or postoperative settings 74. To our knowledge, a widely agreed evidence-based intravenous dosage regimen has not been developed for intravenous clonidine.…”

Sedation, sleep-promotion, and non-verbal and verbal communication techniques in critically ill intubated or tracheostomized patients: results of a survey

“…They were the predominant sedatives used in our group of tracheostomized patients. It is of note that dexmedetomidine and clonidine were used with similar frequencies, while in the international literature only dexmedetomidine appears to be applied, although little data on the comparative effects of both drugs are available [ 36 ].…”