Preoperative and Postoperative Use of Clonidine with Neurolept Anaesthesia

Abstract

The abrupt cessation of clonidine therapy can induce a withdrawal syndrome. This may also appear immediately after anaesthesia if clonidine medication is discontinued during the operation day. We studied (1) whether the withdrawal syndrome occurs postoperatively as often as otherwise when clonidine therapy is discontinued, and (2) the action of this clonidine withdrawal on the circulation as compared to patients who received clonidine without interruption during the operation day. During the recovery period in 2 out of 10 patients in whom clonidine medication was discontinued, a hypertensive crisis occurred, which was relieved by clonidine readministration. Clonidine given with premedication eliminated high rises in blood pressure during anaesthesia. During the recovery period, the regular intramuscular administration of the same dose of clonidine as the patients had used orally decreased blood pressure to almost normotensive levels. The slightly increased urinary catecholamine excretion and plasma renin activity in these patients might, however, indicate that the circulatory homeostasis was disturbed in some degree. The results suggest that it is important to give clonidine continuously, even during the operation day. The dose may be the same as, or preferably somewhat smaller than that which the patients have previously received orally.

The Potentiation of Halothane Anaesthesia by Clonidine

“…(%midine is a short-acting drug: three doses daily are usually required to maintain its antihypertensive action. Because the abrupt cessation of clonidine medication can induce a withdrawal syndrome (HUNYOR et al 1973, GOLDBERG et al 1977, it has been recommended that clonidine should continue to be administered on the operation day (BRODSKY & BRAVO 1976, KAUKINEN et al 1979. Therefore, it is a common practice to anaesthetize patients who are receiving clonidine medication.…”

“…The abrupt cessation of clonidine therapy can induce a withdrawal syndrome which consists of a hypertensive crisis and other symptoms of sympathetic overstimulation (HUNYOR et al , GOLDBERC et al 1977. Clonidine therapy must thus be continued throughout the day of operation in order to avoid the possible withdrawal syndrome (BRODSKY & BRAVO 1976, KAUKINEN et al 1979). Because of its sedative effect it could be expected that clonidine also potentiates the action of anaesthetics.…”

Clonidine as a drug for intravenous conscious sedation

“…In the field of anesthesiology, reports on the relationship between clonidine and anesthesia appeared in the late 1970s. In 1978, Kaukinen et al 21 reported that the use of clonidine as premedication for neuroleptanalgesia suppressed the elevation of blood pressure during anesthesia. In recent years, with the development of the more selective a 2 -agonists, experimental and clinical studies have been conducted chiefly on the analgesic, sedative, and anesthetic effects of a 2 -agonists.…”

“…In recent years, with the development of the more selective a 2 -agonists, experimental and clinical studies have been conducted chiefly on the analgesic, sedative, and anesthetic effects of a 2 -agonists. 20,21 The actions of clonidine on the cardiovascular system include a centrally exerted antihypertensive action, resulting in bradycardia through the activation of presynaptic a 2 -receptors at the peripheral cardiac sympathetic nerve endings, 22 and an action on the coronary arteries that increases the coronary blood flow by releasing an endothelium-derived relaxing factor (nitric oxide). 14 The antihypertensive and coronary blood flow-increasing actions are considered to be favorable in patients with hypertension or ischemic heart disease, but excessive bradycardia and hypotension are not desirable.…”

Comparison of efficacy between clonidine and Dexmedetomidine in attenuating the cardiovascular response to laryngoscopy & intubation in laparoscopic cholecystectomy

“…The alpha 2-adenoceptor agonist have been used as premedicants because of their beneficial properties in anesthesia. Clonidine, which is mainly used as an antihypertensive agent, has many properties of an ideal premedicant, and it also has beneficial effect on the hemodynamics during stressful conditions like laryngoscopy and endotracheal intubation [15] . The effect of clonidine on the hemodynamic variable are dose related, but increase in dose to more than 4 micrograms/kg do not further enhance the efficacy.…”