Clonidine and cardiac surgery: haemodynamic and metabolic effects, myocardial ischaemia and recovery.
Clonidine may have beneficial effects in patients undergoing major surgery. We enrolled 156 patients having elective CABG surgery in a double-blind, randomized trial. Patients were randomized to receive either two doses of placebo (Group PP) or clonidine 5 micrograms/kg (Group CC). Perioperative measurements included haemodynamics, anaesthetic and analgesic drug usage, creatinine clearance, cortisol excretion, recovery times and quality of life (SF-36) after surgery. Overall, there was no significant difference with time to tracheal extubation (median [10-90 centile]): CC 7.1 (3.4-18) h vs PP 8.0 (4.3-17) h, P = 0.70; but there was a higher proportion of patients extubated within four hours: CC 20% vs. PP 8%, P = 0.038. Clonidine resulted in a number of significant (P < 0.05) haemodynamic changes, particularly pre-CPB: less tachycardia and hypertension, more bradycardia and hypotension. Clonidine was associated with a significant (P < 0.05) reduction in anaesthetic drug usage, higher creatinine clearance, lower cortisol excretion and improvement in some aspects of quality of life. This study lends support to consideration of clonidine therapy in patients undergoing CABG surgery.
Myles
P S
PS
Department of Anaesthesia, Alfred Hospital, Melbourne, Victoria.
Hunt
J O
JO
Holdgaard
H O
HO
McRae
R
R
Buckland
M R
MR
Moloney
J
J
Hall
J
J
Bujor
M A
MA
Esmore
D S
DS
Davis
B B
BB
Morgan
D J
DJ
D000316:Adrenergic alpha-Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D000368:Aged; D018686:Anesthetics, Intravenous; D003000:Clonidine / Q000494:pharmacology / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D006973:Hypertension / Q000188:drug therapy; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D017202:Myocardial Ischemia / Q000517:prevention & control*; D010101:Oxygen Consumption / Q000187:drug effects; D011183:Postoperative Complications / Q000517:prevention & control; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D011788:Quality of Life; D013610:Tachycardia / Q000188:drug therapy
D000316:Adrenergic alpha-Agonists; D018686:Anesthetics, Intravenous; D003404:Creatinine; D003000:Clonidine; D006854:Hydrocortisone; D015742:Propofol