Oral clonidine: a simple yet effective and safe premedicant for hemodynamic stability during laparoscopic surgery and a calm post-operative period

Authors

  • Ketaki Marodkar Department of Anaesthesiology, NKPSIMS and RC, Nagpur, Maharashtra, India
  • Anjali Savargaonkar Department of Anaesthesiology, GMCH, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20160707

Keywords:

Oral clonidine, Premedication, Laparoscopy, Pneumoperitoneum, Haemodynamics

Abstract

Background: Laparoscopy is the essence of modern surgery but the carbon dioxide pneumoperitoneum used therein significantly impairs patient’s cardiopulmonary function. Clonidine, by its central sympatholysis, reduces perioperative hemodynamic instability and also has multiple added advantages in post-operative period.

Methods: In this prospective, randomized, double-blind, placebo-controlled study on 60 ASA I/II patients, clonidine 150 µg for weight <55 kg and 200 µg for weight >55 kg was administered per oral to 30 patients (clonidine group) 90 minutes before induction of general anaesthesia and intra-operative haemodynamics were monitored at specific time periods and compared with the placebo group patients (n=30) who received oral vitamin C. We also noted pre-operative anxiety score, post-operative sedation and pain scores and the presence of nausea-vomiting, shivering and dry mouth at the end of first and sixth postoperative hours.

Results: Clonidine group patients remained haemodynamically stable throughout the intra-operative period. In clonidine group, less number of patients required fentanyl for tachycardia (1 vs 11) and NTG for hypertension (none vs 7). Similarly the pain and anxiety scores were significantly less in clonidine group patients. At the end of first postoperative hour incidence of pain, shivering and vomiting in placebo group was 33%, 36% and 20% respectively whereas in clonidine group incidence was 6%, 0 and 0. At the end of 6 post-operative hours, incidence of pain and vomiting was 73% and 36% in placebo group whereas it was 10% and 0 in clonidine group.

Conclusions: Oral clonidine in the present dose is able to maintain stable intra-operative haemodynamics and achieve a calm post-operative period during laparoscopic surgeries in ASA I/II patients. 

References

Osborne DA, Alexander G, Boe B, Zervos EE. Laparoscopic cholecystectomy: past, present and future. Surg Technol Int. 2006;15:81-5.

Thune A, Appalgren L, Haglind E. Prevention of post-operative nausea and vomiting after laparoscopic cholecystectomy. Eur J Surg. 1995;161:265-8.

Koivusalo AM, Scheinin M, Tikkanen I, Yli-Suomu T, Ristkari S, Laakso J et al. Effects of esmolol on hemodynamic responses to CO2 pneumoperitoneum for laparoscopic surgery. Acta Anaesthesiol Scand. 2008:510-7.

Feig BW, Berger DH, Doughtery TB. Pharmacological interventions can reestablish baseline hemodynamic parameters during laparoscopy. Surgery. 1994;116:733-7.

Jee D, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increases during laparoscopic cholecystectomy. Br J Anaesth. 2009;103(4):484-9.

Kamibayashi T, Maze M. Clinical uses of α-2 adrenergic agonist. Anaesthesiol. 2000;93:1345-9.

Hall JE, Uhrich TD, Ebert TJ. Sedative, analgesic and cognitive effects of clonidine infusions in humans. BJA. 2001;86:05-11.

Raval DL, Mehta MK. Oral clonidine pre medication for attenuation of haemodynamic response to laryngoscopy and intubation. IJA. 2002;46(2):124-9.

Schulte-Tamburen AM, Scheier J, Briegel J, Schwender D, Peter K. Comparison of five sedation scoring systems by means of auditory evoked potentials. Intensive Care Med. 1999;25(4):377-82.

Dexter SPL, Vucevic M, Gibson J, McMahon MJ. Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy Surg Endosc. 1999;13(4):376-81.

Gurusamy KS, Samraj K, Davidson BR. Abdominal lift for laparoscopic cholecystectomy. Cochrane database Syst Rev. 2008;16(2):CD006574.

Bhandari D, Tidke S, Sharma V, Dongre H, Garg D, Dhande P. Hemodynamic changes associated with laparoscopic cholecystectomy: Effect of oral clonidine premedication. IOSRPHR. 2012;2(4):72-7.

Ishizaki Y, Bandae Y, Shimomaura K, Abe H, Ohotoma Y, Idezuki Y. Safe intra-abdominal pressure of CO2 pneumoperitoneum during laparoscopic surgery. Surgery. 1993;114:549-54.

Yu HP, Hseu SS, Yien HW, Teng YH, Chan KH. Oral clonidine premedication preserves heart rate variability for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2003;47(2):185-90.

Joris J, Chiche JD, Lamy M. Clonidine reduced hemodynamic changes induced by pneumoperitoneum during laparoscopic cholecystectomy. BJA. 1995;74:A124.

Malek J, Knor J, Kurzova A, Lopourova M. Adverse hemodynamic changes during laparoscopic cholecystectomy and their possible suppression with clonidine premedication. Comparison with intravenous and intramuscular premedication. Rozhl Chir. 1999;78(6):286-91.

Das M, Ray M, Mukherjee G. Haemodynamic changes during laparoscopic cholecystectomy: effect of clonidine premedication. IJA. 2007;51(3):205-10.

Chandrashekaraiah MM, Upadya M, Jayachandran SP, Wali M. Effects of clonidine premedication on hemodynamic changes during laparoscopic cholecystectomy- a randomized control study. Applied Cardiopulm Pathophysiol. 2011;15:91-8.

Sung CS, Lin SH, Chan KH, Chang WK, Chow LH, Lee TY. Effect of oral clonidine premedication on perioperative haemodynamic response & postoperative analgesic requirement for patients undergoing laparoscopic Cholecystectomy. Acta. Anesthesiol Sin. 2000;38:23-9.

Singh S, Arora K. Effect of oral clonidine premedication on perioperative haemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. IJA. 2011;55:26-30.

Javaherfroosh F, Pipelzadeh MR, Namazi M. Clonidine reduces post-operative nausea and vomiting in laparoscopic gynecological surgery. Pak J Med Sci. 2009;25:782-5.

Nicolaou G, Chen AA, Johnston CE, Kenny GP, Bristow GK, Giesdbrecht GG. Clonidine decreases vasoconstriction and shivering threshold without affecting the sweating threshold. Can J Anaesth. 1997;44:636-44.

Tripathi DC, Shah KS, Dubey SR, Doshi SM, Raval PV. Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication. J Anaesthesiol Clin Pharmacol. 2011;27(4):475-80.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. IJA. 2011;55(4):352-7.

Downloads

Published

2016-12-28

How to Cite

Marodkar, K., & Savargaonkar, A. (2016). Oral clonidine: a simple yet effective and safe premedicant for hemodynamic stability during laparoscopic surgery and a calm post-operative period. International Journal of Basic & Clinical Pharmacology, 5(2), 293–299. https://doi.org/10.18203/2319-2003.ijbcp20160707

Issue

Section

Original Research Articles