Clonidine and Cardiac Surgery: Haemodynamic and Metabolic Effects, Myocardial Ischaemia and Recovery

Abstract

Clonidine may have beneficial effects in patients undergoing major surgery. We enrolled 156 patients having elective CABG surgery in a double-blind, randomized trial. Patients were randomized to receive either two doses of placebo (Group PP) or clonidine 5 µg/kg (Group CC). Perioperative measurements included haemodynamics, anaesthetic and analgesic drug usage, creatinine clearance, cortisol excretion, recovery times and quality of life (SF-36) after surgery. Overall, there was no significant difference with time to tracheal extubation (median [10-90 centile]): CC 7.1(3.4-18) h vs PP 8.0(4.3-17) h, P=0.70; but there was a higher proportion of patients extubated within four hours: CC 20% vs. PP 8%, P=0.038. Clonidine resulted in a number of significant (P<0.05) haemodynamic changes, particularly pre-CPB: less tachycardia and hypertension, more bradycardia and hypotension. Clonidine was associated with a significant (P<0.05) reduction in anaesthetic drug usage, higher creatinine clearance, lower cortisol excretion and improvement in some aspects of quality of life. This study lends support to consideration of clonidine therapy in patients undergoing CABG surgery.

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

“…Substantial reductions in the need for various anaesthetics have been demonstrated following administration of clonidine in patients undergoing either cardiac or non-cardiac surgery [33][34][35][36][37]. In patients undergoing CABG surgery, a 45% reduction in the dose of fentanyl needed to reach a similar level of anaesthetic depth was observed when clonidine was given as premedication [36].…”

“…In patients being prepared for surgery, use of clonidine was associated with reductions in BP and HR [33,68,69]. Haemodynamic lability was also attenuated [37,68,[70][71][72], though responses to intubation were not always blunted [33]. Patients premedicated with clonidine 5 µg kg Ϫ1 in preparation for CABG exhibited more favourable intraoperative 364 R. Aantaa and J. Jalonen Comparison of primary haemodynamic parameters in patients undergoing elective plastic surgery (n ϭ 30, ASA I) following premedication with dexmedetomidine (2.5 µg kg Ϫ1 ) or clonidine (4 µg kg Ϫ1 ).…”

Pre-operative Preparation for Cardiac Surgery Utilising a Combination of Metabolic, Physical and Mental Therapy

“…Previous studies have shown that both mental and physical QoL decrease in patients between surgery and 1 month post-operatively. 11,38 Post-operative physical stress in the form of wound healing (chest wound and conduit graft harvesting sites), respiratory distress (pain on deep respiration and cough) is common. In addition, the mental stress associated from being in pain and feeling worse than prior to surgery, significantly decreases mental QoL.…”

Der kardiale Risikopatient in der Anästhesie

“…Die Ergebnisse für die älteste verfügbare Substanz, das Clonidin, sind nicht einheitlich. Für herzchirurgische Patienten wurde keine wirksame Dämpfung der Stressantwort, sondern lediglich eine hämodynamische Stabilisierung gefunden [28,39]. Bei allgemeinchirurgischen Patienten ist eine Unterdrückung der postoperativ erhöh-ten Katecholaminkonzentrationen beschrieben, Auswirkungen auf kardiale Komplikationen wurden aber nicht beschrieben [12].Als neuere Substanz wurde das Mivazerol in großen multizentrischen Studien an Patienten mit KHK oder entsprechenden Risikofaktoren untersucht.…”