title: Preoperative oral dextromethorphan vs. clonidine to prevent tourniquet-induced cardiovascular responses in orthopaedic patients under general anaesthesia.
abstract: OBJECTIVE
  Preoperative oral dextromethorphan and intravenous clonidine attenuate arterial pressure and heart rate increases during tourniquet inflation under general anaesthesia. The effect of preoperative oral clonidine on these variables has not been investigated.
  
  
  METHODS
  We designed this study to compare the effect of preoperative oral dextromethorphan or clonidine on haemodynamic changes during tourniquet inflation in 75 patients undergoing lower limb surgery under general anaesthesia. Patients were randomly assigned into three groups: dextromethorphan 30 mg (n = 25), clonidine 3 microg kg(-1) (n = 25) and placebo (n = 25). Anaesthesia was maintained with isoflurane 1.2% and N2O 50% in oxygen with endotracheal intubation. Dextromethorphan, clonidine or placebo was given orally in a double-blinded fashion 90 min before induction of anaesthesia. Systolic, diastolic and mean arterial pressure and heart rate were measured at 0, 30, 45, 60 min after the start of tourniquet inflation, before tourniquet release and 20 min after tourniquet deflation.
  
  
  RESULTS
  Systolic, diastolic and mean arterial pressure were significantly lower in the clonidine group compared with control after 45, 60 min tourniquet inflation and before tourniquet release (P < 0.05). Twenty minutes after deflation, diastolic and mean arterial pressure in the control group were still increased and significantly higher compared with the clonidine group (P < 0.05). Development of more than a 30% increase in systolic arterial pressure during tourniquet inflation was more frequent in the control group than in the other groups.
  
  
  CONCLUSIONS
  Preoperative oral clonidine 3 microg kg(-1) significantly prevented tourniquet-induced systemic arterial pressure increase in patients under general anaesthesia better than oral dextromethorphan.
authors.affiliation: Department of Anesthesiology and Intensive Care, Isfahan University School of Medicine, Isfahan, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Honarmand
authors.forename: M R
authors.initials: MR
authors.lastname: Safavi
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology*; D000704:Analysis of Variance; D000768:Anesthesia, General; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D003000:Clonidine / Q000008:administration & dosage / Q000494:pharmacology*; D003915:Dextromethorphan / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D019637:Orthopedic Procedures; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors; D014111:Tourniquets / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D000959:Antihypertensive Agents; D003915:Dextromethorphan; D003000:Clonidine