Haemodynamic effects of intravenous clonidine on propofol or thiopental induction

Marinangeli, Franco; Cocco, Claudia; Ciccozzi, Alessandra; Ciccone, Anna Maria; Donatelli, Francesco; Facchetti, Gianluca; Paladini, Antonella; Pasqualucci, Alberto; Varrassi, Giustino

doi:10.1034/j.1399-6576.2000.440204.x

Cited by 12 publications

(14 citation statements)

References 44 publications

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“…There were no statistically significant changes in heart rate observed at the successive stages of induction. However, the tendency towards heart rate increases associated with direct laryngoscopy and endotracheal intubation is visible, which is consistent with the findings of many stud- ies [20,30] and results from stimulation of the sympathetic nervous system. Interestingly, during anaesthesia with propofol, the induction causes increases in the concentration of norepinephrine [4].…”

Section: Discussionsupporting

confidence: 90%

“…The use of a dose of propofol for the induction of anaesthesia has not fully ensured the stability of systemic circulation. Haemodynamic imbalance often accompanies the induction of anaesthesia, which is confirmed by the results of experimental [18] and clinical studies [20,29].…”

Section: Discussionmentioning

confidence: 78%

“…The induction of anaesthesia with propofol is connected with a decrease in arterial pressure accompanied by compensative response from baroreceptors [18][19][20]. Arterial pressure decreases mainly via dilation of the peripheral vascular bed and reduction in cardiac output [21,22].…”

mentioning

confidence: 99%

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Wpływ propofolu na prędkość przepływu krwi w tętnicy środkowej mózgu (VMCA) u chorych z niepękniętym tętniakiem wewnątrzczaszkowym podczas indukcji znieczulenia ogólnego

Karwacki

Niewiadomski²,

Witkowska³

et al. 2018

Anaesthesiol Intensive Ther

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Background: The estimated prevalence of unruptured intracranial aneurysms is 3%. Standard monitoring does not enable one to assess the influence of anaesthetics on the factors determining intracranial homeostasis. Thanks to transcranial Doppler ultrasonography, middle cerebral artery flow velocity (V MCA), reflecting cerebral blood flow, can be measured. The aim of the study was to assess the effects of propofol on intracranial homeostasis in patients with unruptured intracranial aneurysms during the induction of anaesthesia based on V MCA changes. Methods: The study encompassed 21 patients (group II) anaesthetised for elective craniotomy due to unruptured intracranial aneurysms. The control group (group I) included 21 patients who underwent discoidectomy. V MCA , as well as HR, MAP, etCO 2 , and SpO 2 were monitored at the following time points: T 0 -onset of study; T 1 -after 1 minute; T 2 -onset of preoxygenation; T 3 -after 1 minute of preoxygenation; T 4 -administration of fentanyl; T 5 -1 minute after fentanyl; T 6 -administration of propofol; T 7 -1 minute after propofol; T 8 -intubation; T 9 -1 minute after intubation; T 10 -2 minutes after intubation. results: In both groups, no changes in mean HR, etCO 2 and SpO 2 were observed at the successive time points of observation. In groups I and II, an MAP decrease between T 6 and T 7 and an MAP increase between T 7 and T 9 were noted. There were no intergroup differences in mean values of MAP at the times of observation. In both groups and bilaterally, a V MCA decrease was recorded between T 6 and T 7 and an increase between T 7 and T 8 . There were no intergroup differences in mean values of V MCA at the times of observation. In both groups, a weak correlation between V MCA and MAP changes was found bilaterally. Conclusions: Propofol depresses the cerebral circulation during the induction of anaesthesia. The presence of an unruptured aneurysm does not affect the reactivity of the cerebral vessels during the induction of anaesthesia with propofol.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 78%

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Wpływ propofolu na prędkość przepływu krwi w tętnicy środkowej mózgu (VMCA) u chorych z niepękniętym tętniakiem wewnątrzczaszkowym podczas indukcji znieczulenia ogólnego

Karwacki

Niewiadomski²,

Witkowska³

et al. 2018

Anaesthesiol Intensive Ther

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“…Imai Y, Mammoto T, et al who investigated the effects of pre-anaesthetic oral clonidine (150 mcg) on Propofol/Fentanyl anaesthesia, reported a reduction of 40% in the propofol requirements. Similar findings were also reported by Hideyuki Higuchi et al, Fehr et al [35][36][37] Patients in group CL were significantly more sedated than the patients in group C, (P < 0.005) which could be explained by the action of clonidine on sleep promoting pathways and locus coeruleus. However, with 150 mcg of clonidine the mean sedation scores in clonidine group were never more than 2 before induction i.e the patients were 'awake but uncommunicative'(as per the sedation score).…”

supporting

confidence: 79%

Comparative clinical study of the effect of oral clonidine premedication on intraoperative haemodynamics in the patients undergoing laparoscopic cholecystectomy

Kotwani

Kamdar

2017

Int Surg J

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Background: Pneumoperitoneum created during laparoscopy results in patho-physiologic changes, especially in the cardiovascular system. Clonidine diminishes stress response by reducing circulating catecholamines and hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. This comparative clinical study was planned compare with controls the effects of oral clonidine premedication (150 micrograms) on the intraoperative haemodynamics during laparoscopic cholecystectomy.Methods: Sixty adult patients between 15-50 years, scheduled for laparoscopic cholecystectomy under general anaesthesia were enrolled in the study. The patients were randomly assigned to two study groups of 30 patients each, Group CL: received oral clonidine (150 microgram) 90 minutes before induction of anaesthesia and Group C: received placebo. Anaesthetic technique was same for both the study groups. Hemodynamic variables (Heart rate, systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and EtCO2 were recorded at specific times - baseline; 90 minutes following study drug administration; induction of anaesthesia; 5 and 10 minutes following intubation; At skin incision; after creation of CO2 pneumoperitoneum and every 15 minutes thereafter till end of surgery; after desufflation; 5 minutes following extubation.Results: Patients in clonidine group had lower HR, SBP and DBP values as compared to control group at all points of time after giving the study drug (P <0.05). Percent change from baseline in HR and Blood pressure at different points of time was significantly high in control group than in clonidine group.Conclusions: Oral clonidine premedication (150 micrograms) is safe and provides perioperative hemodynamic stability in ASA I and II patients undergoing laparoscopic cholecystectomy, and hence can be recommended as a routine premedication for laparoscopic procedures.

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“…Marinangeli F et al studied the haemodynamic effects of intravenous clonidine on thiopental induction. In this study the dose of thiopentone required for induction in control group was 5.80 mg/kg and in clonidine group with 3µg/kg clonidine was 3.8 mg/kg showing reduction of 34% compared to control (p<0.05) [14] . Above authors have found statistically significant reduction of thiopentone dose required for induction in the clonidine group (p<0.05), which concurs with our study.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study of Efficacy of Clonidine in Attenuating Haemodynamic Response to Laryngoscopy and Tracheal Intubation

Acharya¹,

Routray²

2017

AIMDR

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Background: Laryngoscopy and endotracheal intubation is often associated with hypertension and tachycardia because of sympatho-adrenal stimulation. In patients with cardiovascular and cerebrovascular disease, this sudden rise in heart rate and blood pressure can produce myocardial ischemia, pulmonary oedema and cerebral haemorrhage. Many drugs have been tried to blunt this hemodynamic response but none is ideal. Our aim was to study the efficacy of 3µg/kg clonidine intravenously, given 15 minutes before laryngoscopy and intubation in obtunding the hemodynamic response. Methods: One hundred patients were assigned randomly into two groups. Group I (n=50) received 10 ml of normal saline and group II (n=50) received injection Clonidine 3µg/kg diluted to 10 ml normal saline intravenously over 120 seconds, 15 minutes prior to laryngoscopy and intubation. After premedication anaesthesia was induced with thiopentone till loss of eye lash reflex and dose of thiopentone required was recorded. HR, SBP, DBP and MAP were recorded at various time intervals before and after intubation. Results: In group I, following laryngoscopy and intubation, the rise in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were found to be more compared to group II which was statistically significant (p<0.01).In addition Clonidine reduced the requirement of thiopentone and produced arousable sedation after extubation without any side effects like bradycardia and hypotension. Conclusion: Clonidine in the dose of 3µg/kg body weight given intravenously 15 minutes before laryngoscopy and intubation was seen to effectively attenuate the hemodynamic response to laryngoscopy and intubation without any side effects.

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Haemodynamic effects of intravenous clonidine on propofol or thiopental induction

Cited by 12 publications

References 44 publications

Wpływ propofolu na prędkość przepływu krwi w tętnicy środkowej mózgu (VMCA) u chorych z niepękniętym tętniakiem wewnątrzczaszkowym podczas indukcji znieczulenia ogólnego

Wpływ propofolu na prędkość przepływu krwi w tętnicy środkowej mózgu (VMCA) u chorych z niepękniętym tętniakiem wewnątrzczaszkowym podczas indukcji znieczulenia ogólnego

Comparative clinical study of the effect of oral clonidine premedication on intraoperative haemodynamics in the patients undergoing laparoscopic cholecystectomy

A Prospective Randomized Study of Efficacy of Clonidine in Attenuating Haemodynamic Response to Laryngoscopy and Tracheal Intubation

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