Intrathecal clonidine and severe hypotension after cardiopulmonary bypass.
The use of intrathecal clonidine as an adjunct for the management of chronic pain, intra- and postoperative analgesia is gaining an increase in popularity. However, antinociceptive doses of intrathecal clonidine may produce pronounced hemodynamic side effects, including hypotension and bradycardia. In this report, we present a case of severe hypotension after cardiopulmonary bypass in a patient with intrathecal clonidine infusion. We postulate that the intrathecally administered alpha 2-agonist clonidine reduced our patient's ability to tolerate the hemodynamic lability that is present during the separation from cardiopulmonary bypass by potentially inhibiting sympathetic nervous system activity, renin-angiotensin system, or vasopressin release. The authors report a case of severe hypotension after cardiopulmonary bypass in a patient receiving intrathecal clonidine infusion for chronic neuropathic pain.
From the Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, New York.
Ferenc
F
Puskas
Enrico M
EM
Camporesi
Colleen E
CE
O'Leary
Michael
M
Hauser
Fadi V
FV
Nasrallah
D000316:Adrenergic alpha-Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass; D003000:Clonidine / Q000009:adverse effects* / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000139:chemically induced*
D000316:Adrenergic alpha-Agonists; D003000:Clonidine