Clonidine premedication in spinal anaesthesia: Effect on hemodynamic status and vasopressor response to ephedrine

Vasantha Shetty; Aarti Deepak; Manisha B. S.; Reshma Koteshwara

doi:10.51248/.v43i5.3633

Authors

Vasantha Shetty
Aarti Deepak
Manisha B. S.
Reshma Koteshwara

DOI:

https://doi.org/10.51248/.v43i5.3633

Keywords:

Clonidine, ephedrine, haemodynamics, spinal anaesthesia

Abstract

Introduction: Premedication has an important role to play in modern day anaesthesia care. In recent years, clonidine is making a comeback as a premedicant. Our study deals with haemodynamic changes to ephedrine after oral clonidine premedication for spinal anaesthesia with or without concurrent administration of drugs.The purpose of the study is to know the effect of oral clonidine premedication on haemodynamic status including vasopressor response of ephedrine during spinal anaesthesia.

Materials: This is a prospective randomized double blinded controlled study. Sixty adult patients belonging to ASA I scheduled for elective surgery under spinal anaesthesia were selected. The patients were randomly assigned to 2 groups.Oral clonidine 4 microgram/kg was administered to group A(Clonidine group, n equal to 30) and 90 and one tablet of vitamin (placebo) orally 90 minutes was administered to group B (Control group, n equal to 30)90 minutes prior to anaesthesia. On the morning of surgery, blood pressure was measured before premedication and 90 minutes later. Sedation and anxiolysis were scored during clonidine premedication and 90^th minute afterwards. When SBP decreased to 80% of the pre-spinal value, bolus IV injection of ephedrine 0.1 mg/kg was administered. After ephedrine injections, blood pressure and heart rate were recorded at 1 minute interval for 10 minutes.

Results: Group A patients were found to have low SBP, DBP, MBP and HR when compared to group B. Intravenous ephedrine augmented blood pressure more than the control group. Statistically significant difference was found for SBP after 5 minutes, for MBP after 4 minutes of ephedrine administration and no significant difference was found for DBP.

Conclusion: We conclude from our study that clonidine administered orally in a dose of 4 microgram/kg as a premedicant increases the pressor responses to IV injection ephedrine 0.2 mg/kg in patients with subarachnoid block.

Author Biographies

Vasantha Shetty

Department of Anaesthesiology, A J Institute of Medical Sciences & Research Centre, Kuntikana, Mangalore, 575004, Karnataka, India

Aarti Deepak

Department of Anaesthesiology, A J Institute of Medical Sciences & Research Centre, Kuntikana, Mangalore, 575004, Karnataka, India

Manisha B. S.

Department of Anaesthesiology, A J Institute of Medical Sciences & Research Centre, Kuntikana, Mangalore, 575004, Karnataka, India

Reshma Koteshwara

Shree Atal Bihari Vajpayee Medical College and Research Institute, Bangalore, Karnataka, India

References

Bernard, J.M., Pinard, M. Clonidine from the treatment of hypertension to its use in anaesthesia. Dept. of Anaesthesiology, Chirugicale Nantes Ann. Fr. Anaesthesia Reanim. 1990; 9 (5): 423-432.

Stuhmeir, K.D., Mainze, B., Cierpka, J., Sandmann, W., Tarhow, J. Small oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery.Anaesthesiology. 1996; 85: 706-712.

Nishikawa, T., Dohi, S. Oral clonidine blunts the heart rate response to intravenous atropine in humans. Anaesthesiology. 1999;75: 217-222.

Filos, K.S., Patroni, O., Goudas, L.C. A dose response study of orally administered clonidine as premedication in elderly; Evaluating hemodynamic safety. Anesth Analg 1993; 77: 1185 -1192.

Zoukas, Y., Thomaides, T., Chandrari, K.R., Pavitt, D.V., Cuzner, M.L., Mathias, C.J. Expression of beta adrenoceptors on circulating and after reduction of central sympathetic flow by clonidine. Blood Pressure 1994;3(3):172-177.

Zoukas, Y., Thomaides, T., Pavitt, D.V., Leonard, J.P., Cuzner, M.L., Mathias, C.J. Upregulation of beta-adrenoceptors on circulating mononuclear cells after reduction of central sympathetic outflow by clonidine in normal subjects. Clin Auton Res 1992;2: 165-170.

Inomata, S., Nishikawa, T., Kihara, S., Akiyoshi, Y. Enhancement of pressor response to intravenous phenylephrine following oral clonidine medication in awake and anaesthetised patients. Can J Anaesth 1995; 42: 119-125.

Kock, M.D., Laterre, P.F., Obbergh, L.V., Carlier, M., Leret, J. The effects of intraoperative intravenous clonidine on fluid requirements, hemodynamic variables and support during liver transplantation: A prospective, randomized study. Anesth Analg 1998; 86: 468-476.

Parlow, J.L., Sagnard, Begou, G., Viale, J.P., Quintin, L. The effects of clonidine on sensitivity to phenylephrine and nitroprusside in patients with essential hypertension recovering from surgery. Anesth Analg 1999; 88:1239-1243.

Nishikawa, T., Kumura, T., Taguchi, N., Dohi. S. Oral clonidine premedication augments the pressor response to intravenous ephedrine in awake or anesthetized patients. Anesthesiology 1991; 74: 705-710.

Tanaka, M., Nishikawa, T. Enhancement of pressor response to ephedrine following clonidine medication. Anaesthesia 1996; 51: 123-127.

Goyagi, T., Tanaka, M., Nishikawa, T. Oral clonidine premedication enhances the pressure response to ephedrine during spinal anaesthesia. Anesth Analg 1998; 7:1336 -1339.

Nishina, K., Mikawa, K., Maekawa, N., Obara, H. Oral clonidine premedication blunts the heart rate response to intravenous atropine in awake children. Anaesthesiology 1995;82(5):1126-1130.

Houston, J. Clonidine hydrochloride. Review of Pharmacologic and Clinical Aspects. Prog. Cardiovascular Disease 1987; 23: 337.

Arevalo, J.V. Clonidine and left ventricular function in patients with arterial hypertension. Tribuna Med 1983; 68:29.

Miller, R.D. Anaesthesia. Churchill Livingstone,5th ed. Vol.1: 554-555.

Ghigone, M., Noe, C., Calvillo, O. Anaesthesia for opthalmic surgery in elderly. The effects of clonidine on intraocular pressure and perioperative hemodynamic changes and anaesthetic requirements. Anesthesiology, 1988: 68:707-716.

Bloor, B.C., Finander, L.S., Flacke, W.E., Etten, A.V. Effect of clonidine on sympathoadrenal response during sodium nitroprusside hypotension. Anesth Analg 1986; 65: 469-474.

Azad, A., Kats, R.I., Patel, R.V. The effect of oral clonidine on the duration of lidocaine spinal anaesthesia. Anesthesiology. 1994;81: A944.

Dodd, J.M., Breslow, M.J., Dorman, T., Rosen, B.A. Preserved sympathetic response to hypotension despite perioperative alpha2 agonist administration. Anesth Analg 1997; 84:1208-1210.

Watanabe, Y., Lida, H., Tanabe, K., Obata, H., Dohi, S. Clonidine premedication modifies responses to adrenoceptor agonists and baroreflex sensitivity. Cana. J. Anaesth 1998; 45:1084-1090.

Muzi, M., Godd, D.R., Kampine, J.P. Clonidine reduces sympathetic activity but maintains baroreflex responses in humans. Anesthesiology 1992; 77: 864-871.

Korner, P.I., Oliver, J.R., Sleight, P., Robinson, J.S., Chalmers, J.P. Assessment of cardiac autonomic excitability in renal hypertensive rabbits using clonidine induced resetting of baroreceptor - heart rate reflex. Eur J. Pharmacol. 1975; 33: 353 -362.

Mancia, G., Ferrari, A., Gregorini, L., Zanchetti, A. Clonidine and carotid basoreflex in normotension and essential hypertension. Hypertension 1979; 1:362-370.

Engelman, E., Lipszyc, M., Gilbast, E., Vander Linden, P., Bellens, B., Van Romphey, A., et al., Effects of clonidine on anesthetic drug requirements and hemodynamic response during aortic surgery. Anesthesiology 1989; 71: 178-187.