Abstract
The present study was conducted to examine the haemodynamic and endocrine effects of clonidine, given as sole preanaesthetic medication, in neurosurgical patients. Nineteen patients of ASA physical status I and II, subjected to craniotomy, randomly received po premedication of either clonidine (300 μg, n=9) or placebo (n=10). Blood pressure and heart rate were monitored continuously, while arterial blood samples were collected at specific times, from induction of anaesthesia to recovery, for the measurement of plasma concentrations of epinephrine, norepinephrine, cortisol, aldosterone, and glucose. Clonidine treatment led to a decrease in mean arterial blood pressure (MABP), heart rate (HR), and plasma cortisol and aldosterone concentrations throughout the study, compared with placebo (P<0.05). Clonidine, however, did not prevent increases in MABP (16±5 mmHg, mean ±SE, P<0.05) and HR (18±4 bpm, P<0.05) during induction of anaesthesia, which was comparable to the placebo group. Plasma catecholamine concentrations did not differ between the two groups. Plasma glucose concentrations increased in both groups at the end of the study (P<0.05), but were lower in clonidine-treated patients (P<0.05). Though statistically significant, the observed inhibitory haemodynamic and endocrine effects of clonidine seem to be of minor clinical importance. As the action of clonidine on cerebral blood flow regulation is not well known, we see no advantage in the preanaesthetic administration of clonidine to neurosurgical patients with normal cardiovascular status.
Résumé
Cette étude fut conduite afin d’examiner les affets hémodynamiques et endocriniens de la clonidine administrée comme seule prémédication chez les patients neurochirurgicaux. Dixneuf patients ASA classe I et II, devant subir une craniotomie, furent randomisés afin de recevoir une prémédication orale soit de clonidine (300 μg, n=9)_ou un placebo (n=10). La pression artérielle et la fréquence cardiaque furent surveillées continuellement alors que des échantillons sanguins furent prélevés à des temps précis à partir de l’induction de l’anesthésie jusqu’au réveil pour la mesure des concentrations plasmatiques d’épinéphrine, norépinéphrine, cortisol, aldostérone et glucose. Le traitement à la clonidine a amené une diminution dans la pression artérielle moyenne (PAM), la fréquence cardiaque (FR), et les concentrations plasmatiques de cortisol et d’aldostérone à travers l’étude comparativement au placebo (P<0.05). La clonidine, cependant, n’a pas empêché l’augmentation de la PAM (16±5 mmHg, moyenne ±SE, P<0.05) et FR (18±4 bpm, P<0.05) lors de l’induction de l’anesthésie fut comparable au groupe placebo. Les concentrations plasmatiques de catécholamines n’étaient pas différentes entre les deux groupes. Les concentrations plasmatiques de glucose ont augmenté dans les deux groupes à la fin de l’étude (P<0.05) mais étaient moindres chez les patients traités à la clonidine (P<0.05). Même si statistiquement significatifs, les effets hémodynamiques et endocriniens de la clonidine semblent avoir une importance clinique mineure. Etant donné que l’action de la clonidine sur la régulation du flux sanguin cérébral n’est pas connue, on ne voit aucun avantage dans l’administration pré-anesthésique de la clonidine chez les patients neurochirurgicaux avec un état cardiovasculaire normal.
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References
Jarrott B, Conway EL, Maccarrone C, Lewis SJ. Clonidine: understanding its disposition, sites and mechanism of action. Clin Exp Pharmacol Physiol 1987; 14: 471–9.
Lipman JJ, Spencer PSJ Further evidence for a central site of action for the antinociceptive effects of clonidine-like drugs. Neuropharmacology 1979; 18: 731–3.
Maze M, Birch B, Vickery RG Clonidine reduces halothane MAC in rats. (Letter) Anesthesiology 1987; 67: 868–9.
Unnerstall JR, Kopajtic TA, Kuhar MJ. Distribution of alpha2-agonist binding sites in the rat and human central nervous system: analysis of some functional, anatomie correlates of the pharmacologic effects of clonidine and related adrenergic agents. Brain Res Rev 1984; 319: 69–101.
Ghignone M, Quintin L, Duke PC, Kehler CH, Calvillo O. Effects of clonidine on narcotic requirements and hemodynamic response during induction of fentanyl anesthesia and endotracheal intubation. Anesthesiology 1986; 64: 36–42.
Ghignone M, Calvillo O, Quintin L. Anesthesia and hypertension: the effect of clonidine on perioperative hemodynamics and isoflurane requirements. Anesthesiology 1987; 67: 3–10.
Ghignone M, Noe C, Calvillo O, Quintin L. Anesthesia for ophthalmic surgery in the elderly: the effects of clonidine on intraocular pressure, perioperative hemodynamics, and anesthetic requirement. Anesthesiology 1988; 68: 707–16.
Flacke JW, Bloor BC, Flacke WE et al. Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology 1987; 67: 11–9.
Engelman E, Lipszyc M, Gilbart E et al. Effects of clonidine on anesthetic drug requirements and hemodynamic response during aortic surgery. Anesthesiology 1989; 71: 178–87.
Longnecker DE. Alpine Anesthesia: can pretreatment with clonidine decrease the peaks and valleys? (Editorial) Anesthesiology 1987; 67: 1–2.
Shapiro HM. Anesthesia effects upon cerebral blood flow, cerebral metabolism, electroencephalogram, and evoked potentials.In: Miller RD (Ed.), Anesthesia, 2nd ed., New York: Churchill Livingstone Inc.; 1986: 1249–88.
Bouloux P, Perrett D, Besser GM. Methodological considerations in the determination of plasma catecholamines by high performance liquid chromatography with electrochemical detection. Ann Clin Biochem 1985; 22: 194–203.
Leclerq R, Copinschi G, Franckson JRM. Le dosage par compétition du cortisol plasmatique. Modification de la méthode de Murphy. Revue Française d’Etudes Cliniques et Biologiques 1969; 14: 815–9.
Lowenthal DT, Matzek KM, MacGregor TR. Clinical pharmacokinetics of clonidine. Clin Pharmacokinets 1988; 14: 287–310.
Ziegler MG. Antihypertensive therapie.In: Chernow B (Ed.). The Pharmacological Approach to the Critically Ill Patient. Baltimore: Williams & Wilkins, 1988; 365–88.
Laurito CE, Baughman VL, Becker GL, DeSilava TW, Carranza CJ Is clonidine the ideal pre-operative medication? (Abstract) Anesthesiology 1989; 71: A23.
Bullington J, Mouton Perry SM, Rigby J et al. The effect of advancing age on the sympathetic response to laryngoscopy and tracheal intubation. Anesth Analg 1989; 68: 603–8.
Lanes R, Herrera A, Palacios A, Moncada G. Decreased secretion of cortisol and ACTH after oral clonidine administration in normal adults. Metabolism 1983; 32: 568–70.
Moore RA, McQuay HJ. Neuroendocrinology of the postoperative state.In: Smith G, BG Covino (Eds.). Acute Pain. Stoneham MA, Butterworths, 1985; 133–54.
Oyama T, Taniguchi K, Jin T, Satone T, Kudo T. Effects of anaesthesia and surgery on plasma aldosterone concentration and renin activity in man. Br J Anaesth 1979; 51: 747–52.
Todd MM, Warner DS. Perioperative fluid management in neurosurgery. Current Opinion in Anesthesiology 1989; 2: 559–63.
DeFronzo RA, Sherwin RS, Felig P Synergistic interactions of counterregulatory hormones: a mechanism for stress hyperglycemia. Acta Chirur Scand 1980; 498 (Suppl): 33–41.
Metz SA, Halter JB, Robertson RP. Induction of defective insulin secretion and impaired glucose tolerance by clonidine. Selective stimulation of metabolic alpha-adrenergic pathways. Diabetes 1978; 27: 554–62.
Joffe BI, Haita B, Edelstein D et al. Clonidine and the hormonal response to graded excercise in healthy subjects. Horm Res 1986; 23: 136–41.
Sieber FE, Smith DS, Traystman RJ, Wollman H. Glucose: a reevaluation of its intraoperative use. Anesthesiology 1987; 67: 72–81.
Kehlet H. Modification of responses to surgery by neural blockade: clinical implications.In: Cousins MJ, Bridenbaugh PO (Eds.) Neuronal Blockade in Clinical Anesthesia and Management of Pain. Philadelphia: JB Lippincott, 1988; 145–88.
Roizen MF, Horrigan RW, Frazer BM Anesthetic doses blocking adrenergic (stress) and cardiovascular responses to incision — MAC BAR. Anesthesiology 1981; 54: 390–8.
Gelman S, Rivas JE, Erdemir H et al. Hormonal and haemodynamic responses to upper abdominal surgery during isoflurane and balanced anaesthesia. Can Anaesth Soc J 1984; 31: 509–16.
Kanawati IS, Yaksh TL, Anderson RE, Marsh RW. Effects of clonidine on cerebral blood flow and the response to arterial CO2. J Cereb Blood Flow Metab 1986; 6: 358–65.
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This work was supported by the Fonds National Suisse No 3.495-086 (RWR).
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Gaumann, D.M., Tassonyi, E., Rivest, R.W. et al. Cardiovascular and endocrine effects of clonidine premedication in neurosurgical patients. Can J Anaesth 38, 837–843 (1991). https://doi.org/10.1007/BF03036957
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DOI: https://doi.org/10.1007/BF03036957