Evaluation of Oral Tiazinidine Effects on [intraoperative] Hemodynamic Responses During Direct Laryngoscopy Under General Anesthesia

Abstract

BackgroundDirect laryngoscopy and tracheal intubation can result in blood pressure and heart rate increase which in turn may lead to myocardial ischemia, cerebral hemorrhage, and even death in susceptible patients. Tizanidine is α2-receptor agonists that suppresses central sympathetic system.ObjectivesThis study evaluates the effects of oral Tizanidine on hemodynamic responses during operations and aims to determine the appropriate Propofol dosage to maintain anesthesia under BIS monitoring.Materials and MethodsA double-blind clinical trial has been performed on 70 candidates for elective abdominal surgery undergoing general anesthesia in Educational Hospital of Ghaem, Mashhad, Iran. 35 randomly selected patients (the case group) were given 4 mg of oral Tizanidine 90 minutes before the induction of anesthesia whereas the remaining subjects (the control group) were given placebo. Blood pressure and heart rate before and after induction of anesthesia, and after intubation and extubation, existence of postoperative shivering, and the needed Propofol dosage were measured and recorded. Data analysis was done with T-test and Chi-squared test, using SPSS software version 16.ResultsVariations of blood pressure and heart rate after anesthesia induction, intubation and extubation were less in Tizanidine group generally. Postoperative shivering was reported in 28.6% and 11.4% of patients in control and case group respectively. Average propofol needed dose for anesthesia maintenance in case group was 25% less than the needed amount in the control group.ConclusionsUsing oral Tizanidine as a premedication, yielded stability in blood pressure and heart rate during surgery and decreased required Propofol. Considering its short duration of action, Tizanidine use as a premedication is recommended for sedation and stabilization of hemodynamic responses during the operations.

A randomised controlled double blind study to assess the effect of oral tizanidine premedication on intraoperative isoflurane consumption in patients undergoing laparoscopic surgeries under general anaesthesia

“…We did observe lower heart rate in tizanidine patients at multiple time intervals of preoperative, intraoperative and postoperative period. Similar observations were seen by Tabari et al 17 with lower baseline variations of heart rate with tizanidine premedication group compared with placebo group. As compared with other alpha 2 agonists, 1,2,15,25 we did not observe episodes of severe bradycardia, hypotension, AV block, rebound hypertension requiring pharmacological correction which suggests tizanidine to be associated with stable haemodynamics.…”

“…Tabari and workers. 17 observed significantly lower propofol dose for anaesthesia maintainence with 4mg tizanidine premedication. With inhalational anaesthetics, Wajima et al 5 found that 4 mg tizanidine premedication reduced the MAC of sevoflurane by 18% in adults.…”

Is Preemptive Oral Tizanidine Effective on Postoperative Pain Intensity after Bimaxillary Orthognathic Surgery? A Triple-Blind Randomized Clinical Trial

“…Since patients who have undergone orthognathic surgery receive intermaxillary fixation (IMF) with either wires or elastics for a 7-14 day period postoperatively, PONV can possibly cause aspiration of gastric contents and be extremely life-threatening 1, 2, 5, 8 . Tizanidine is a centrally active α 2 -agonist, which has proven clinically efficacious in managing muscle spasticity [12][13][14] . This medication is structurally similar to clonidine and also has sedative, antianxiety, and analgesic properties [12][13][14][15][16][17] .…”

“…Tizanidine is a centrally active α 2 -agonist, which has proven clinically efficacious in managing muscle spasticity [12][13][14] . This medication is structurally similar to clonidine and also has sedative, antianxiety, and analgesic properties [12][13][14][15][16][17] . Nevertheless, side-effects such as hypotension and bradycardia seem to be less severe when tizanidine is prescribed instead of clonidine 5,[12][13][14][15][16][17] .…”

“…This medication is structurally similar to clonidine and also has sedative, antianxiety, and analgesic properties [12][13][14][15][16][17] . Nevertheless, side-effects such as hypotension and bradycardia seem to be less severe when tizanidine is prescribed instead of clonidine 5,[12][13][14][15][16][17] . Tizanidine reduces the need for opioids, benzodiazepine, and anesthesia medications during and after patient intubation in the operating room [12][13][14][15][16][17][18] .…”