Clonidine and ketamine for stable hemodynamics in off-pump coronary artery bypass

Patel, Jigar; Thosani, Rajesh; Kothari, Jignesh; Garg, Pankaj; Pandya, Himani

doi:10.1177/0218492316663359

Cited by 12 publications

(4 citation statements)

References 16 publications

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“…It was reported that the combination of ketamine and clonidine was more effective than the nebulization of ketamine alone and caused no serious adverse effects including hemodynamic instability (Shekhar et al, 2019 ). Jigar Patel et al also found that combined low-dose clonidine and ketamine-induced perioperative sedation and effective suppression of sympathetic response with stable hemodynamics (Patel et al, 2016 ). This study also showed that the combination of Dex and Esk could synergically enhance each other in sedation and analgesia.…”

Section: Discussionmentioning

confidence: 99%

A Single Low Dose of Dexmedetomidine Efficiently Attenuates Esketamine-Induced Overactive Behaviors and Neuronal Hyperactivities in Mice

Chu

Zhu

Bai

et al. 2021

Front. Hum. Neurosci.

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Introduction: Esketamine (Esk) (S(+)-ketamine) is now used as an alternative to its racemic mixture, i. e., ketamine in anesthesia. Esk demonstrated more powerful potency and rapid recovery in anesthesia and less psychotomimetic side effects comparing with ketamine, but Esk could still induce psychological side effects in patients. This study was to investigate whether dexmedetomidine (Dex) can attenuate the Esk-induced neuronal hyperactivities in Kunming mice.Methods: Dexmedetomidine 0.25, 0.5, and 1 mg/kg accompanied with Esk 50 mg/kg were administrated on Kunming mice to assess the anesthesia quality for 1 h. The indicators, such as time to action, duration of agitation, duration of ataxia, duration of loss pedal withdrawal reaction (PWR), duration of catalepsy, duration of righting reflex (RR) loss, duration of sedation, were recorded for 1 h after intraperitoneal administration. The c-Fos expression in the brain was detected by immunohistochemistry and Western Blot after 1 h of administration. Considering the length of recovery time for more than 1 h in Dex and Dex with Esk groups, other mice were repeatedly used to evaluate recovery time from the administration to emerge from anesthesia.Results: Dexmedetomidine dose-dependently increased recovery time when administrated with Esk or alone. Dex combined with Esk efficiently attenuated the duration of agitation, ataxia, and catalepsy. Dex synergically improved the anesthesia of Esk by increasing the duration of sedation, loss of RR, and loss of PWR. Esk induced the high expression of c-Fos in the cerebral cortex, hippocampus, thalamus, amygdala, hypothalamus, and cerebellum 1 h after administration. Western Blot results indicated that Dex at doses of 0.25, 0.5, and 1 mg/kg could significantly alleviate the Esk-induced c-Fos expression in the mice brain.Conclusion: Dexmedetomidine ranged from 0.25 to 1 mg/kg could improve the anesthesia quality and decreased the neuronal hyperactivities and the overactive behaviors when combined with Esk. However, Dex dose-dependently increased the recovery time from anesthesia. It demonstrated that a small dose of Dex 0.25 mg/kg could be sufficient to attenuate Esk-induced psychotomimetic side effects without extension of recovery time in Kunming mice.

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Section: Discussionmentioning

confidence: 99%

A Single Low Dose of Dexmedetomidine Efficiently Attenuates Esketamine-Induced Overactive Behaviors and Neuronal Hyperactivities in Mice

Chu

Zhu

Bai

et al. 2021

Front. Hum. Neurosci.

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“…One RCT investigating intravenous clonidine alone and in combination with ketamine versus a placebo described stable intraoperative hemodynamics as well as increased sedation scores and decreased pain scores postoperatively after bypass surgery, although the statistical significance of the difference was not reported (category D evidence). 91 The literature supported the perioperative use of intravenous dexmedetomidine as an analgesic adjunct for patients undergoing cardiac surgery as it reduced pain scores 92 and/or opioid consumption [92][93][94] as well as decreased extubation time 93 and ICU/ hospital 93 LOS (category A2-B evidence 92,93 /category B1-B evidence 94 ).…”

Section: Literaturementioning

confidence: 98%

Section: Intraoperative Managementmentioning

confidence: 99%

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

Makkad

Heinke

Sheriffdeen

et al. 2023

Anesthesia &Amp; Analgesia

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Patients after cardiac surgery experience moderate to severe pain in the immediate postoperative period as a result of surgical interventions, such as incision, sternotomy, sternal retraction, pericardiotomy, tissue dissection, and the presence of chest tubes. 1 Poorly controlled acute pain increases suffering, cardiovascular stress, and respiratory complications and may develop into persistent postoperative pain, which adversely affects patients' daily activities, psychological well-being, and quality of life. 2

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“…Journal of Anesthesia & Intensive Care Medicine trunk [10], the formation of controlled hypotension [11], use of local vasoconstrictor agents like epinephrine and phenylephrine [12], and use of premeditations [13]. Clonidine is an alpha-2 adrenergic agonist [14] and an antihypertensive agent which plays its role mainly by suppressing sympathetic activity [15], and causes central regulation of vasoconstrictor tone [16]. Studies have approved the effect of clonidine premedication before anesthesia in reducing bleeding in otolaryngology surgeries [17,18].…”

mentioning

confidence: 99%

Comparison of the Effects of Clonidine, Promethazine, and Morphine on Bleeding During Rhinoplasty Surgery: A Triple-blind Clinical Trial Study

Zangoue

2019

JAICM

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Introduction: Intraoperative bleeding is a complication of rhinoplasty which directly affects the outcome of the surgery and the hemodynamic indices of the patient. Different approaches like administration of premedication's, head elevation, and use of vasoconstrictor agents like phenylephrine and epinephrine and have been used to minimize the amount of blood loss.Objective: To compare the impact of clonidine, promethazine, and morphine drugs used as premedication on bleeding during rhinoplasty. Methods:In this clinical trial study, 60 patients of those referred to ENT clinic of Vali-e-Asr Hospital for rhinoplasty and met the inclusion criteria, were chosen by convenience sampling and were divided into three groups, 20 patients in each, by permuted block randomization. Anesthesia method was the same in these groups. One hour before the surgery, patients in the clonidine and promethazine groups received 300µg clonidine and 25mg promethazine orally, respectively, and patients in the morphine group received 0.1mg/Kg of morphine intramuscularly. Data were analyzed by SPSS software version 15 using One-way ANOVA, Tukey, Kruskal-Wallis, and Mann-Whitney U tests. A P-value less than 0.05 was considered statistically significant.Results: This study showed that the mean amount of bleeding during surgery was less in the clonidine group compared with other groups, but this difference was not significant (P=0.07). Systolic blood pressure, heart rate per minute, and erythrocyte saturation rate immediately after intubation, 0.5, 1, 1.5, and 2 hours after intubation showed no considerable difference between the groups (P>0.05). The surgeon's satisfaction with the surgery was significantly higher in the clonidine group patients (P=0.04). Conclusion:Average bleeding in the clonidine group patients was less than other patients and that the result is not statistically significant may be due to small sample size. With regard to higher satisfaction of the surgeon with clonidine, we suggest it is used as a premedication in rhinoplasties.

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Clonidine and ketamine for stable hemodynamics in off-pump coronary artery bypass

Cited by 12 publications

References 16 publications

A Single Low Dose of Dexmedetomidine Efficiently Attenuates Esketamine-Induced Overactive Behaviors and Neuronal Hyperactivities in Mice

A Single Low Dose of Dexmedetomidine Efficiently Attenuates Esketamine-Induced Overactive Behaviors and Neuronal Hyperactivities in Mice

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

Comparison of the Effects of Clonidine, Promethazine, and Morphine on Bleeding During Rhinoplasty Surgery: A Triple-blind Clinical Trial Study

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