Premedication with Oral and Transdermal Clonidine Provides Safe and Efficacious Postoperative Sympatholysis

• Published in: Anesthesia and analgesia Vol. 79; no. 6; pp. 1133 - 1140
• Main Authors: Ellis, John E., Drijvers, Greet, Pedlow, Steven, Laff, Scott P., Sorrentino, Matthew J., FOSS, Joseph F., Shah, Manish, Busse, J. R., Mantha, Srinivas, McKinsey, James F., Osinski, Joachim, Thisted, Ronald A., Roizen, Michael F.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-12-1994; Lippincott
• Subjects: Administration, Cutaneous; Administration, Oral; Aged; Anesthesia - methods; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Clonidine - administration & dosage; Clonidine - adverse effects; Clonidine - blood; Coronary Disease - physiopathology; Double-Blind Method; Drug Administration Schedule; Electrocardiography - drug effects; Enflurane; Female; Heart Rate - drug effects; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - prevention & control; Neuropharmacology; Nitrous Oxide; Pharmacology. Drug treatments; Placebos; Postoperative Care; Premedication; Receptors, Adrenergic - drug effects; Receptors, Adrenergic - physiology; Risk Factors; Sufentanil; Surgical Procedures, Operative; Sympatholytics - therapeutic use; Urodynamics - drug effects; Human; Cardiovascular disease; Coronary heart disease; Myocardial disease; Vascular disease; Prevention; Chemotherapy; Treatment; General anesthetic; Ischemia; Surgery; Myocardium; Complication; Drug interaction; Premedication
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/00000539-199412000-00019

We studied 61 patients undergoing elective major non-cardiac surgery in a randomized, double-blind, placebo-control clinical trial to test the hypothesis that the addition of clonidine to a standardized general anesthetic could safely provide postoperative sympatholysis for patients with known or suspected coronary artery disease. Patients were allocated randomly to receive either placebo (n = 31) or clonidine (n = 30). The treatment group received premedication with a trans-dermal clonidine system (0.2 mg/d) the night prior to surgery, which was left in place for 72 h, and 0.3 mg oral clonidine 60–90 min before surgery. Clonidine reduced enflurane requirements, intraoperative tachycardia, and myocardial ischemia (1/28 clonidine patients vs 5/24 placebo, P = 0.05). However, clonidine decreased heart rates only during the first five postoperative hours; the incidence of postoperative myocardial ischemia (6/28 clonidine vs 5/26 placebo) did not differ between the two groups. Patients who experienced postoperative myocardial ischemia tended to have higher heart rates after surgery. Clonidine significantly reduced the plasma levels of epinephrine (P = 0.009) and norepinephrine (P = 0.026) measured on the first postoperative morning. There were no differences in the need for intravenous fluid therapy or antihypertensive therapy after surgery. The number of hours spent in an intensive care setting and the number of days spent in hospital were not different between the two groups. These results suggest that larger doses of clonidine should be investigated for their ability to decrease postoperative tachycardia and myocardial ischemia. (Anesth Analg 1994;79:1133–40)