Effect of oral clonidine premedication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients.
OBJECTIVE
To examine how premedication with clonidine affects opioid use, hemodynamic effects, hormonal responses, and recovery effects.


METHODS
Double blind, placebo-controlled study.


METHODS
Operating room and surgical intensive care unit of a university medical center.


METHODS
54 patients undergoing elective coronary artery bypass graft (CABG) surgery.


METHODS
Patients received approximately 5 micrograms/kg of oral clonidine or a placebo together with 40 micrograms/kg lorazepam 90 minutes prior to titrated sufentanil induction of anesthesia. Thirty minutes prior to cardiopulmonary bypass, a second dose of either approximately 5 micrograms/kg clonidine or placebo was given as a slurry via a nasogastric tube.


RESULTS
Opioid use, hemodynamic effects, hormonal responses, and recovery effects were recorded. Values for ten hemodynamic variables were compiled on the evening prior to surgery, prior to induction, and during seven additional events and compared. Catecholamines and beta-endorphins were measured prior to induction, after intubation, and after sternotomy. The amount of sufentanil used for induction, maintenance, and total opioid were compared. The times to awakening and response to verbal commands were compared. The two groups exhibited similar patient demographics, cardiopulmonary bypass time, and duration of surgery. Patients receiving clonidine required significantly (p < 0.04) less sufentanil for induction (clonidine: 2.19 +/- 0.95 micrograms/kg vs. placebo: 2.93 +/- 1.07 micrograms/kg) and total amount of sufentanil (clonidine: 9.1 +/- 3.9 micrograms/kg vs. placebo: 11.7 +/- 4.6 micrograms/kg). Patients receiving clonidine required significantly (p < 0.01) less isoflurane (9.7 +/- 6.8 MAC min vs. 19.7 +/- 9.9 MAC min) to maintain heart rate (HR) and mean arterial pressure (MAP) to within 15% of baseline without significant differences in other vasoactive drugs. Catecholamine concentrations were significantly (p < 0.02) lower in patients receiving clonidine without any difference in beta-endorphin concentrations. Patients receiving clonidine had significantly (p < 0.02) lower HR, systolic arterial pressure, MAP, and systemic vascular resistance prior to induction than patients receiving placebo without differences in other hemodynamic variables.


CONCLUSIONS
Clonidine decreases opioid use and lowers hormonal response while maintaining stable hemodynamics in patients undergoing CABG with sufentanil anesthesia.
Howie
M B
MB
Department of Anesthesiology, Ohio State University Medical Center, Columbus 43210-1228, USA.
Hiestand
D C
DC
Jopling
M W
MW
Romanelli
V A
VA
Kelly
W B
WB
McSweeney
T D
TD
D000316:Adrenergic alpha-Agonists / Q000009:adverse effects; D000758:Anesthesia; D000762:Anesthesia Recovery Period; D003000:Clonidine / Q000009:adverse effects; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006728:Hormones / Q000097:blood; D006801:Humans; D008140:Lorazepam; D008297:Male; D008875:Middle Aged; D011229:Preanesthetic Medication / Q000009:adverse effects; D017409:Sufentanil
D000316:Adrenergic alpha-Agonists; D006728:Hormones; D017409:Sufentanil; D003000:Clonidine; D008140:Lorazepam