title: Clonidine and ketamine for stable hemodynamics in off-pump coronary artery bypass.
abstract: BACKGROUND
  The current era of fast-track extubation and faster recovery after cardiac surgery requires agents that provide perioperative sedation, suppress sympathetic response, reduce opioid requirement, and maintain hemodynamic stability.
  
  
  METHODS
  In a prospective randomized double-blind study, 75 off-pump coronary artery bypass patients were divided into 3 groups of 25 each: group A had clonidine 1 µg·kg(-1), group B had clonidine 1 µg·kg(-1) and ketamine 1 mg·kg(-1), and group C had a saline placebo. Perioperative changes in heart rate, systolic and diastolic blood pressure, sedation score, pain score, and requirement of analgesics, beta blockers, fentanyl, propofol, and inotropes were recorded, as well time to extubation, intensive care unit stay, and 30-day mortality.
  
  
  RESULTS
  The combination of clonidine and ketamine led to stable hemodynamics and reduced beta-blocker dosage. The sedation score was highest in groups A and B up to 24 h postoperatively. The pain score was lowest in group B in the first 24 h, and the total dose of analgesics was highest in group C. Clonidine and ketamine or clonidine alone reduced extubation time, but intensive care unit stay was unchanged
  
  
  CONCLUSIONS
  Combined low-dose clonidine and ketamine produced perioperative sedation and effective suppression of sympathetic response with stable hemodynamics. Intraoperative beta-blocker use was reduced without increasing inotrope requirement. This combination prolonged the analgesic effect of opioids, reducing postoperative pain score and analgesic requirement. Low-dose clonidine alone produced sedation but did not completely block sympathetic response. Intensive care unit stay and patient outcome were not affected by clonidine or ketamine.
authors.affiliation: Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, India jigar.ane@gmail.com.
authors.forename: Jigar
authors.initials: J
authors.lastname: Patel
authors.affiliation: Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Thosani
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, India.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Kothari
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.affiliation: Department of Research, UN Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, India.
authors.forename: Himani
authors.initials: H
authors.lastname: Pandya
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D060666:Airway Extubation; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000778:Anesthetics, Dissociative / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003000:Clonidine / Q000009:adverse effects / Q000627:therapeutic use*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007194:India; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D013565:Sympatholytics / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D013565:Sympatholytics; D007649:Ketamine; D003000:Clonidine
keywords: Off pump coronary artery bypass; Pain score; Sedation score; Vasoactive Inotropic Score; Visual Analog Scale