Efficacy of Clonidine for Prevention of Perioperative Myocardial Ischemia

Nishina, Kahoru; Mikawa, Katsuya; Uesugi, Takanobu; Obara, Hidefumi; Maekawa, Munetaka; Kamae, Isao; Nishi, Nobuo

doi:10.1097/00000542-200202000-00016

Cited by 121 publications

(36 citation statements)

References 2 publications

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“…This is still a controversial issue, however some authors have compared the effect of clonidine to that of beta-blockers on myocardial protection [1][2][3]12 . In this study, clonidine presented a sedative effect similar to that of diazepam, with an autonomic control characteristic of alpha-2 agonists, thus decreasing myocardial work.…”

Section: Discussionmentioning

confidence: 99%

Efeitos sedativos e cardiovasculares do midazolam e do diazepam, associados ou não a clonidina, em pacientes submetidos a estudos hemodinâmicos por suspeita de doença arterial coronariana

Nascimento

Módolo

Silva

et al. 2007

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Efeitos sedativos e cardiovasculares do midazolam e do diazepam, associados ou não a clonidina, em pacientes submetidos a estudos hemodinâmicos por suspeita de doença arterial coronariana

Nascimento

Módolo

Silva

et al. 2007

Arq. Bras. Cardiol.

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“…These findings are confirmed and reinforced by a large body of literature. 12, 13,15,[49][50][51][52][53][55][56][57][58]67,69,70 Clonidine is a mixed alpha agonist drug possessing peripheral ␣1 and ␣2 activity as well as imidazoline agonist effects. In low doses it primarily produces central ␣2 effects.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] Additional investigations have shown that clonidine pretreatment also increases skin temperature 16 and decreases the difference between fingertip and forearm temperatures. 17 These results suggest an increase in cutaneous blood flow.…”

mentioning

confidence: 98%

Oral Clonidine Pretreatment Prior to Venous Cannulation

Hall

Rezvan

Tatakis

et al. 2006

Anesthesia Progress

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Clonidine is a preferential alpha-2 agonist drug that has been used for over 35 years to treat hypertension. Recently, it has also been used as a preoperative medication and as a sedative/anxiolytic drug. This randomized, double-blind, placebo-controlled crossover clinical trial characterized the effects of oral clonidine pretreatment on intravenous catheter placement in 13 patients. Parameters measured included the bispectral index (BIS), Observer's Assessment of Alertness/Sedation Scale (OAA/S), frontal temporal electromyogram (EMG), 30-Second Blink Count (Blink), Digit Symbol Substitution Test (DSST), State Anxiety Inventory (SAI), fingertip versus forearm skin temperatures, and multiple questionnaires. Oral clonidine significantly decreased SAI scores, OAA/S, EMG, and Blink, but did not cause statistically significant BIS or DSST reductions. Subjects preferred oral clonidine pretreatment prior to venipuncture compared to placebo. Questionnaires also indicated that clonidine provided minimal sedation, considerable anxiolysis, and some analgesia. Fingertip versus forearm skin temperature differentials were decreased. Reduced fingertip versus forearm temperature differentials suggest increased peripheral cutaneous blood flow prior to venous cannulation. Oral clonidine pretreatment not only helped control patient anxiety and pain but also provided cardiovascular stability.Key Words: Clonidine; Venous cannulation; BIS; SAI; DSST.I ntravenous (IV) catheters have become the accepted standard of care for general anesthesia and IV sedation. 1 Catheterization of peripheral veins can be made more comfortable using a variety of techniques, including local anesthesia infiltration, 2,3 nitrous oxide inhalation, 2,4,5 ethyl chloride topical, 4,6 eutectic mixture of local anesthetics (lidocaine-prilocaine) cream, 7,8 tetracaine patches, 9 and even midazolam nasal spray. 10 The goals of these methods are pain and anxiety reduction with minimal invasiveness and lack of significant complications. An additional benefit of some cannulation pretreatments is cutaneous vasodilation.Previous medical anesthesia/sedation studies have indicated that clonidine administration prior to surgery decreases pain 11,12 and anxiety 12 and also stabilizes blood pressure and heart rate by reduction of central sympathetic outflow. [13][14][15] Additional investigations have shown that clonidine pretreatment also increases skin temperature 16 and decreases the difference between fingertip and forearm temperatures. 17 These results suggest an increase in cutaneous blood flow. 18 The purpose of this randomized, double-blind, placebo-controlled crossover clinical trial was to characterize the sedative/anxiolytic effects and changes in skin temperatures of oral clonidine pretreatment prior to IV catheter placement. METHODSThe study protocol and informed consent form were approved by The Ohio State University Institutional Review Board. Inclusion criteria were (a) adults with American Society of Anesthesiologists ASA1 or ASA2 health status, (b) severe ...

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“…Eine einzige Metaanalyse zum perioperativen Einsatz von Kalziumkanalblockern zeigte in der Posthoc-Analyse eine reduzierte Inzidenz perioperativer Myokardinfarkte, allerdings auch eine erhöhte Inzidenz an Hypotensionen [14]. Die Datenlage für den α 2 -Agonisten Clonidin ist zwar positiv, aber bis auf eine kleine Metaanalyse ebenfalls dünn [10]. Eine Statintherapie sollte prä-operativ nicht unterbrochen werden, da auch dies eine Destabilisierung koronarer Plaques zur Folge haben kann [7].…”

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Perioperative myocardial damage in patients undergoing non-cardiac surgery

Möllhoff

Kress

2009

Anaesthesist

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Efficacy of Clonidine for Prevention of Perioperative Myocardial Ischemia

Cited by 121 publications

References 2 publications

Efeitos sedativos e cardiovasculares do midazolam e do diazepam, associados ou não a clonidina, em pacientes submetidos a estudos hemodinâmicos por suspeita de doença arterial coronariana

Efeitos sedativos e cardiovasculares do midazolam e do diazepam, associados ou não a clonidina, em pacientes submetidos a estudos hemodinâmicos por suspeita de doença arterial coronariana

Oral Clonidine Pretreatment Prior to Venous Cannulation

Perioperative myocardial damage in patients undergoing non-cardiac surgery

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