COMPARISON OF ESMOLOL, CLONIDINE, AND LIGNOCAINE FOR SUPPRESSION OF HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION AS AN ADJUVANT TO FENTANYL IN ADULT PATIENTS UNDERGOING ELECTIVE SURGERY

Introduction: Laryngoscopy and endotracheal intubation lead to a strong sympathetic response, this study was done to compare clonidine, esmolol, and lignocaine as an adjuvant to fentanyl to attenuate the pressor response to laryngoscopy during endotracheal intubation. To compare clonidine, esmolol, and lignocaine as an a Objectives: djuvant to fentanyl to attenuate the pressor response to laryngoscopy during endotracheal intubation. A Randomized prospective study includi Material and Methods: ng 150 normotensive patients undergoing elective surgical procedures were included. Three groups were divided according to drug they received. After 3 minutes of drug , laryngoscopy and endotracheal intubation were done. Vitals (HR,SBP,DBP and MAP) were noted before laryngoscopy and endotracheal intubation and 1,2,4,6 and 8 minute after Laryngoscopy and endotracheal intubation and anaesthesia was continued with O2+N2O+Sevoflurane. Results: Rise in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at one minute following intubation in all three groups of drugs (p<0.001). SBP both esmolol and clonidine reached equal to baseline in 4 mins with their respective p-value as 0.293 and 0.097 and group lignocaine reached equal to baseline in 6 mins. DBP of group esmolol reached baseline at 4 mins (p-value- 0.090), group clonidine reached baseline in 6 mins. And group lignocaine does not reach baseline even after 8 mins. MAP in esmolol group reached to baseline in 4 mins, group clonidine reached to baseline in 6 mins and group lignocaine does not reach to baseline even after 8 mins. Conclusion: Considering all parameters, it was concluded that esmolol with fentanyl showed better response on all parameters.

Comparative Study Between Intravenous Clonidine and Preservative Free Intravenous Lignocaine in Attenuation of Pressor Response to Laryngoscopy and Endotracheal Intubation

Objectives To compare the attenuation of pressor responses by intravenous clonidine and preservative-free lignocaine to laryngoscopy and endotracheal intubation. Materials and Methods A randomized, prospective, comparative, double-blinded study was conducted in 80 adult patients who were randomized into two groups of 40 each, group clonidine (Group C) and group lignocaine (Group L). Group C patients were given 2 µg/kg clonidine in 20 ml of normal saline as a slow infusion over 10 min prior to intubation. Group L patients were given 1.5 mg/kg of preservative-free 2% lignocaine in 20 ml of normal saline as a single-dose infusion over 3 min prior to intubation. Baseline vital and hemodynamic parameters were monitored during the perioperative period at 1-, 5-, and 10-min post-intubation. Results The attenuation of heart rate (HR) after intubation was much better with clonidine than lignocaine as there is statistically significant difference in the mean HR between the two groups at 1, 5, and 10 min after intubation with the HR significantly lesser in the Group C than the Group L at all times after intubation. Both clonidine and lignocaine were effective in attenuating systolic blood pressure response after intubation, but clonidine was more effective than lignocaine as systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in the Group C remained much lower than the Group L and the difference between the two groups was statistically significant at all times after intubation. Conclusion Premedicating with a single slow infusion of 2 µg/kg i.v. clonidine has been proven to be effective in maintaining perioperative hemodynamic stability at 1, 5, and 10 min post-intubation than lignocaine.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a metaanalysis of randomised controlled trials

Abstract Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to Clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02-208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55-185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25-238.58; I2 = 99%; GRADE approach evidence-high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60-2.41 ; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63-10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than Clonidine.

Preoperative Anxiety Among Cardiac Surgery Patients and Its Impact on Major Adverse Cardiac Events and Mortality– A Randomized, Parallel?Group Study

Background:Patients undergoing elective cardiac surgery often experience pre?operative anxiety. Preoperative anxiety influences surgical outcome. There are very few studies which have assessed the impact of clonidine and Gabapentin in the treatment of anxiety especially in Indian populations and its implications on major adverse cardiac events (MACE) and 30 days mortality. Materials and Methods: Adult patients aged 18 to 80 years old who were scheduled to have an elective coronary artery by?pass graft (CABG) were included in the study.Those who satisfied the inclusion criteria were given either Gabapentin (800 mg) or Clonidine (300 mcg) 90?120 minutes before the induction. State trait anxiety inventory (STAI) was used to assess anxiety in baseline and taking just before operating room. The primary endpoint was a reduction in the STAI associated with the study drug, while the secondary endpoint was the incidence of MACE in the perioperative period (30 days), which included composite episodes of non?fatal cardiac arrest, chaotic rhythm, acute myocardial infarction, congestive heart failure, cardiac arrhythmia, angina, and death. Results: A total of 75 patients were considered for the statistical analysis. The demographic and clinical features of the study participants were similar in both groups. Nearly 75?80% of participants had severe anxiety in the preoperative period while 10?20% had moderate anxiety. While both the drugs showed a reduction in the anxiety levels, the clonidine group fared better (statistically insignificant). The incidence of MACE was similar in both groups. Conclusion:The preoperative anxiety levels were high among cardiac surgery patients.Both clonidine and gabapentin were equally effective in reducing the levels of preoperative anxiety. Preoperative STAI scores in the range of 32?53 is not associated with MACE and 30?day mortality among cardiac surgery patients.

Comparative efficacy of 600 mg oral gabapentin and 300 mcg oral clonidine in attenuation of pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy

Background: Endotracheal intubation and laryngoscopy are harmful stimulus, which can trigger unwanted cardiovascular conditions such as hypertension, dysrhythmia, and tachycardia. Various drugs have been used to attenuate the cardiovascular response. Drugs such as clonidine and Gabapentin are in extensive usage to stabilize the hemodynamic responses. Aim and Objectives: The aim of the study was to assess the efficacy of 600 mg oral Gabapentin and 300 mcg oral clonidine in attenuating pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy. Materials and Methods: This prospective randomized study consists of 100 cases between the age group 21 and 65 years posted for elective surgery under general anesthesia. The study cases were randomly divided into two groups. Group 1 (n = 50) administered with 600 mg oral Gabapentin and Group 2 (n = 50) administered with 300 mcg oral clonidine. The baseline and pre-operative hemodynamic parameters and levels of sedation score and anxiety scores were recorded. Results: The total duration of intubation was 26.53 min in Group 1 and 26.86 min in Group 2. The systolic blood pressure, diastolic blood pressure, mean heart rate, mean arterial pressure, sedation score, and anxiety score were comparable between the two study groups and the mean difference between the two study groups was statistically significant (P < 0.05). Conclusion: Both study drugs had similar significant anxiolysis and sedation scores. However, 300 ?g oral clonidine has better hemodynamic stability to laryngoscopy and intubation than 600 mg oral gabapentin.

Comparison of onset of action of Intrathecal Clonidine vs Intrathecal Fentanyl as an adjuvant with hyperbaric Bupivacaine and Bupivacaine alone under spinal anesthesia for lower limb orthopedic surgeries

Background: Adjuvants are added to a local anesthetic solution to prolong the duration of analgesia. There is a paucity of studies comparing the onset of action of adjuvants like Clonidine and Fentanyl. In this study, the time of onset of action of intrathecal clonidine and intrathecal fentanyl as adjuvants to bupivacaine and bupivacaine alone were compared in the subarachnoid block for lower limb orthopedic surgeries. Materials and Methods: 90 adult patients posted for orthopedic surgery of the lower limb were divided into three equal groups of 30 each. Group A being the control group was given hyperbaric Bupivacaine(3ml) +0.5ml of Normal saline, Group B was given Intrathecal hyperbaric Bupivacaine (3 ml) +30 ?g Clonidine and Group C was given Intrathecal hyperbaric Bupivacaine (3 ml) + Fentanyl 25 ?g. The primary objective was to compare the time of onset of block and duration of analgesia. The secondary outcomes were the duration of sensory and motor block, duration of analgesia, hemodynamic parameters, and side effects. Results: The time of onset of the sensory blockade was 4.83 ± 0.64, 1.72 ± 1.47, and 3.4 ± 1.43 mins in groups A, B, and C respectively. The time of onset of the motor blockade as estimated by the time to reach level 2 on the Bromage scale, was 6.07 ± 0.55, 2.38 ± 1.32, and 5.06 ± 1.28 mins in groups A, B, and C respectively. The duration of postoperative analgesia was prolonged in the Clonidine group compared to the Fentanyl group. Conclusion: The study reveals that the time of onset of action of sensory and motor block was faster and the duration of analgesia was prolonged with adjuvants like Clonidine when compared to Fentanyl when added to Bupivacaine.

Continuous clonidine infusion: an alternative for children on mechanical ventilation

SUMMARY OBJECTIVE: This study aimed to assess the clonidine infusion rate in the first 6 h, as maintenance dose (first 24 h), and in the pre-extubation period (last 24 h), as well as the cumulative dose of other sedatives and the hemodynamic response. METHODS: This is a retrospective cohort study. RESULTS: Children up to the age of 2 years who were admitted to the pediatric intensive care unit of a tertiary referral hospital in the south region of Brazil, between January 2017 and December 2018, were submitted to mechanical ventilation, and received continuous clonidine infusions were included in the study. The initial, maintenance, and pre-extubation doses of clonidine; the vasoactive-inotropic score; heart rate; and systolic and diastolic blood pressure of the study participants were assessed. A total of 66 patients with a median age of 4 months who were receiving clonidine infusions were included. The main indications for mechanical ventilation were acute viral bronchiolitis (56%) and pneumonia associated with acute respiratory distress syndrome (15%). The median of clonidine infusion in the first 6 h (66 patients) was 0.53 μg/kg/h (IQR 0.49-0.88), followed by 0.85 μg/kg/h (IQR 0.53-1.03) during maintenance (57 patients) and 0.63 μg/kg/h (IQR 0.54-1.01) during extubation period (42 patients) (p=0.03). No differences were observed in the doses regarding the indication for mechanical ventilation. Clonidine infusion was not associated with hemodynamic changes and showed no differences when associated with adjuvants. CONCLUSION: Clonidine demonstrated to be a well-tolerated sedation option in pediatric patients submitted to mechanical ventilation, without relevant influence in hemodynamic variables.

0.25% Bupivacaine with 8 mg Dexamethasone and 50 mcg Clonidine as adjuvant on fascia iliaca compartment block in open reduction and internal fixation surgeries to femoral fractures-a prospective randomized study

Background: Fascia iliaca compartment nerve block (FICB) is commonly preferred pain management technique in femoral fractures. Dexamethasone and clonidine as adjuvants to local anesthetics have good analgesic effect with limited adverse effect. Aim and Objectives: To assess the efficacy of bupivacaine with clonidine, bupivacaine with dexamethasone, and bupivacaine alone in fascia iliaca compartment block in cases with femoral fractures. Materials and Methods: The present prospective randomized study included a total of 120 cases undergoing proximal femoral surgeries under subarachnoid block above 21 years. The study cases were randomly divided into three study groups, i.e. 40 participants in each group. Group 1 received 0.25% bupivacaine with 2 ml normal saline, Group 2 received 0.25% bupivacaine with 50mcg clonidine, and Group 3 received with 0.25% bupivacaine with 8mg dexamethasone. Parameters such as heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation levels, and visual analog scale (VAS) score was monitored and recorded. Results: The mean difference of HR between the study groups was statistically not significant (P > 0.005). The mean SBP, DBP, and VAS score was comparable between study groups. The mean analgesic duration in Group 1 was 6.01 h, in Group 2 was 13.58 h, and in Group 3 was 14.44 h. The mean difference of rescue analgesia requirement and duration of rescue analgesia was statistically significant. No adverse effects toward drugs were noticed. Conclusion: About 0.25% bupivacaine with 8 mg Dexamethasone had better analgesic duration and require minimal rescue analgesia in the first postoperative day than 0.25% bupivacaine with 50 mcg clonidine in cases undergoing femoral surgeries under FICB.

Extended stability study of an extemporaneously analgesic solution of clonidine, ropivacaine and fentanyl

Abstract The aim of this work was to perform an extended stability study for the analgesic containing fentanyl, clonidine and ropivacaine in physiological saline solution 0.9% at different infusion sites, such as infusion bags, epidural infusion sets and syringes. The extended stability was assessed by an HPLC system equipped with a photodiode array detector set at 210 nm. The separation was conducted on a C18 column maintained at 40˚C and using an isocratic mobile phase consisted of buffer solution-methanol-acetonitrile (45:45:10, v/v/v). The presence of particulate matter and the pH of each solution were also investigated. Twenty-four hours after the preparation, the formation of one suspected product was observed and for all drugs, in 24 hours it was observed the concentration decrease in different sets (PVC infusion bags, syringes and epidural infusion administration sets). The pH values of each solution varied no more than 5% during the study and no particle was observed. Conclusion: The extended stability study was applied to the analgesic solution and promoted the detection of an unexpected peak in 24 hours. Based on it, further stability studies are necessary to determine the extended stability data.

Como a dexmedetomidina e a clonidina devem ser prescritas no ambiente de terapia intensiva? / How should dexmedetomidine and clonidine be prescribed in the critical care setting?

RESUMO O manejo cardíaco, ventilatório e renal no ambiente de terapia intensiva tem melhorado nas últimas décadas. Cognição e sedação representam dois dos últimos desafios a vencer. Como a sedação convencional não é ideal, e a sedação evocada por agonistas adrenérgicos alfa-2 (sedação "cooperativa" com dexmedetomidina, clonidina ou guanfacina) representa uma alternativa valiosa, este artigo abrange três tópicos práticos para os quais há lacunas na medicina baseada em evidência. O primeiro deles é a mudança de sedação convencional para sedação cooperativa ("mudança"): a resposta curta consiste em retirada abrupta de sedação convencional, implantação imediata de infusão de um agonista alfa-2 e uso de "sedação de resgate" (bolos de midazolam) ou "sedação agressiva" (haloperidol em bolos) para estabilizar a sedação cooperativa. O segundo tópico é a mudança de sedação convencional para sedação cooperativa em pacientes instáveis (por exemplo: delirium tremens refratário, choque séptico, síndrome do desconforto respiratório agudo etc.), pois, para evitar a hipotensão e a bradicardia provocadas por desativadores simpáticos, a resposta curta é manter o volume sistólico por administração de volume, vasopressores e inotrópicos. Por fim, para evitar essas mudanças e dificuldades associadas, os agonistas alfa-2 podem ser sedativos de primeira linha. A resposta curta é administrar agonistas alfa-2 lentamente desde a admissão ou intubação endotraqueal, até estabilização da sedação cooperativa. Dessa forma, conclui-se que os agonistas alfa-2 são, ao mesmo tempo, agentes desativadores simpáticos e sedativos, bem como a desativação simpática implica na manutenção do volume sistólico e na avaliação persistente da volemia. A medicina baseada em evidência deve documentar esta proposta.

ABSTRACT Cardiac, ventilatory and kidney management in the critical care setting has been optimized over the past decades. Cognition and sedation represent one of the last remaning challenges. As conventional sedation is suboptimal and as the sedation evoked by alpha-2 adrenergic agonists ("cooperative" sedation with dexmedetomidine, clonidine or guanfacine) represents a valuable alternative, this manuscript covers three practical topics for which evidence-based medicine is lacking: a) Switching from conventional to cooperative sedation ("switching"): the short answer is the abrupt withdrawal of conventional sedation, immediate implementation of alpha-2 agonist infusion and the use of "rescue sedation" (midazolam bolus[es]) or "breakthrough sedation" (haloperidol bolus[es]) to stabilize cooperative sedation. b) Switching from conventional to cooperative sedation in unstable patients (e.g., refractory delirium tremens, septic shock, acute respiratory distress syndrome, etc.): to avoid hypotension and bradycardia evoked by sympathetic deactivation, the short answer is to maintain the stroke volume through volume loading, vasopressors and inotropes. c) To avoid these switches and associated difficulties, alpha-2 agonists may be considered first-line sedatives. The short answer is to administer alpha-2 agonists slowly from admission or endotracheal intubation up to stabilized cooperative sedation. The "take home" message is as follows: a) alpha-2 agonists are jointly sympathetic deactivators and sedative agents; b) sympathetic deactivation implies maintaining the stroke volume and iterative assessment of volemia. Evidence-based medicine should document our propositions.

Cohort Study on the Effectiveness and Safety of Tiapride Combined with Clonidine versus Tiapride and Clonidine Alone for Children with Tic Disorders / 中国药房

OBJECTIVE：To compa re the effectiveness and safety of three regimens of tiapride ，clonidine and tiapride combined with clonidine in the treatment of tic disorder （TD）in children. METHODS ：A sequential collection of 312 children with TD from the outpatient department of West China Second Hospital of Sichuan University were conducted during Jan.-Dec. 2019. They were divided into clonidine group ，tiapride group ，tiapride combined with clo nidine group ，with 104 cases in each group. Tiapride group was given Tiapride hydrochloride tablets with initial dose of 50-100 mg per day ，and the dose was gradually increased to 150-500 mg per day according to tolerance and clinical experience. Clonidine group was given Clonidine transdermal patches ，once a week ，with initial dose of 1 mg each week ，maintenance dose of 1-2 mg each week ，once a week. Tiapride combined with clonidine group was given Tiapride hydrochloride tablets （same usage and dosage as tiapride group ）+ Clonidine transdermal patches （same usage and dosage as clonidine group ）. The treatment course of 3 groups was 3 months. After the treatment ，they were followed up every 3 months（the following were expressed as 24，36 and 48 weeks after treatment ）. Yale global tie severity scale （YGTSS）scores of 3 groups were observed before treatment ，after 4，8，12，24，36，48 weeks of treatment，and the occurrence of ADR was recorded at different follow up time points. RESULTS ：Before treatment ，there was no statistical significance in YGTSS scores among 3 groups（P＞0.05）. After 4，8，12，24，36 and 48 weeks of treatment ，YGTSS scores of 3 groups were significantly lower than those before treatment （P＜0.05）. After 4，8 and 12 weeks of treatment ，YGTSS scores of tiapride combined with clonidine group were significantly lower than tiapride group and clonidine group （P＜0.05），while there was no statistical significance between tiapride group and clonidine group （P＞0.05）. At 24 weeks of treatment ，YGTSS score of children in tiopride combined with clonidine group was significantly lower than tiopride group （P＜0.05），but there were no significant differences between tiopride combined with clonidine group and tiopride group ，and between tiopride group and clonidine group （P＞0.05）. After 36 and 48 weeks of treatment ，there was no significant difference in YGTSS scores among 3 groups（P＞0.05）. After 12 weeks of treatment ，the results of P value corrected by Bonferroni method showed that YGTSS score of tiopride combined with clonidine group was significantly lower than those of tiopride group and clonidine group （P＜0.016 7）， while there was no statistical significance in the difference between tiopride group and clonidine group （P＞0.016 7）. There was no statistically significant difference in the total incidence of ADR among 3 groups（P＞0.05）. CONCLUSIONS ：Clonidine，tiapride and tiapride combined with clonidine can significantly improve the tic symptoms of TD children with good safety .

A Comparison of the Postoperative Analgesic Efficacy of Two Different Doses of Caudal Clonidine as Adjunct to Caudal Bupivacaine in Infraumbilical Surgeries in Younger Children.

Managing peri operative pain in smaller children is challenging but beneficial. Caudal epidural block with local anaesthetic and adjuvant in proper dose can significantly prolong the duration of analgesia while avoiding dose related side effects of both the drugs. We selected clonidine as adjuvant to bupivacaine in caudal blocks for perioperative pain management in 80 children during infra umbilical surgeries performed under general anaesthesia. MethodsThe children were randomly allocated into two groups, Group A (n=40) and Group B (n=40). Group A received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 1 μg/Kg in 1 mL normal saline and Group B received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 0.5 μg/Kg in 1 mL normal saline, after inhalational anaesthesia. Heart rate, blood pressure, respiratory rate, oxygen saturation, sedation score, Bromage score and pain score were monitored and recorded peri-operatively. Time to first rescue analgesic at pain score of 12, total number of rescue analgesic doses required, and side effects were also recorded. Data was analysed using appropriate statistical tests. ResultsGroup B patients had significantly higher heart rates, systolic and diastolic blood pressures, respiratory rates and pain scores compared to Group A patients at 50 mins post operatively. The requirement of rescue analgesics in Group B was earlier and higher than Group A. Group A patients remained haemodynamically stable and pain free for longer period. There was no significant difference in side effects between the groups. ConclusionsAddition of 1 μg/Kg clonidine to caudal epidural bupivacaine improves the quality and prolongs the duration of postoperative analgesia compared to addition of 0.5 μg/Kg clonidine without causing significant side effects.

Respuesta hemodinámica post intubación orotraqueal en pacientes sometidos a cirugía abdominal electiva que reciben clonidina o lidocaína previo a la inducción anestésica / Hemodynamic response after orotracheal intubation in patients undergoing elective abdominal surgery that receive clonidine or lidocaine after anesthesia indutction

Se realizó un ensayo clínico controlado simple ciego con el objetivo de evaluar la respuesta hemodinámica post intubación orotraqueal y efectos adversos con clonidina versus lidocaína en pacientes sometidos a cirugía abdominal electiva con anestesia general en el Hospital Central Universitario Dr. Antonio María Pineda durante el período mayo ­ agosto de 2018. Cincuenta pacientes conformaron la muestra distribuidos aleatoria y equitativamente en dos grupos: el grupo A recibió clonidina a una dosis de 1.5 mcg/kg endovenoso, 20 minutos previos a la inducción anestésica y el grupo B recibió lidocaína a una dosis de 1.5 mg/kg, 90 segundos previos a la inducción anestésica. La edad promedio de los pacientes varió entre 31,6 ± 12,2 años de edad, con predominio del sexo femenino. Los efectos adversos fueron hipotensión al minuto y tres minutos post intubación; sólo dos pacientes del grupo A presentaron bradicardia a los tres minutos. Se observó una diferencia estadísticamente significativa entre ambos grupos en relación a la presión arterial sistólica, diastólica y media y frecuencia cardíaca inmediatamente posterior a la intubación, al minuto y a los tres minutos. Estos resultados confirman que el uso de clonidina es eficaz para atenuar la respuesta hemodinámica posterior a la intubación en pacientes sometidos a cirugía abdominal electiva bajo anestesia general(AU)

A single-blind controlled clinical trial was carried out with the aim to evaluate the hemodynamic response after orotracheal intubation in patients that receive clonidine or lidocaine in patients undergoing elective abdominal surgery with general anesthesia at the Hospital Central Universitario Dr. Antonio María Pineda during the period May - August 2018. Fifty patients were distributed randomly and equitably in two (2) groups: group A received clonidine in a dose of 1.5 mcg/kg intravenously, 20 minutes before anesthetic induction and group B received lidocaine at a dose of 1.5 mg/kg, 90 seconds before anesthetic induction. Median age of patients was 31.6 ± 12.2 years with a predominance of female sex. Most common adverse effect was hypotension in both groups at one and three minutes post intubation; only two patients in the clonidine group showed bradycardia at three minutes. There was a statistical significant difference between both groups in regards to the mean values of systolic, diastolic and mean arterial pressure and heart rate at all time points measured after intubation. These results confirm that clonidine is effective in reducing hemodynamic response after intubation in patients that undergo elective abdominal surgery under general anesthesia(AU)

Seguridad y efectividad de la preparación magistral de clonidina como ansiolítico en pacientes pediátricos sometidos a cirugía ambulatoria / Safety and effectiveness of the magistral preparation of clonidine as an ansiolytic in pediatric patients undergoing ambulatory surgery

Objetivo: evaluar la seguridad y efectividad de la preparación magistral de clonidina a una concentración de 15 µg/mL utilizada para premedicación oral en niños entre uno y siete años de edad a una dosis de 4 µg/kg de peso sometidos a cirugía ambulatoria entre febrero y octubre de 2019 en la Clínica San Marcel. Materiales y métodos: se realizó un estudio observacional descriptivo retrospectivo de corte transversal, con muestreo consecutivo durante el periodo del estudio. Los datos de 202 pacientes fueron obtenidos de la historia clínica para luego realizar el análisis univariado y bivariado con estadística descriptiva. Un valor de P > 0,05 se consideró significativa. Resultados: hubo una incidencia de ansiedad preoperatoria del 2,5%, hipotensión arterial de 30,69% y de bradicardia de 23,26%. No se dieron casos de vómito, escalofrío o depresión respiratoria posoperatorios. La edad estuvo asociada con ansiedad preoperatoria (P=0,03) y bradicardia (P=0,049) pero no con hipotensión arterial (P=0,066). Conclusiones: la preparación magistral de clonidina se asocia con baja incidencia de ansiedad preoperatoria en niños y ausencia de vómito, escalofrío y depresión respiratorias posoperatorias. Sin embargo, preocupa la alta frecuencia de hipotensión arterial y bradicardia encontrados sin que pueda plantearse ninguna asociación..Au

Objectives: to evaluate the safety and effectiveness of the clonidine preparation at a concentration of 15 µg / mL used for oral premedication in children between one and seven years old at a dose of 4 µg / kg of weight undergoing ambulatory surgery between February and October 2019 at the San Marcel Clinic. Materials and methods: a restrospective, descriptive observational cross-sectional study was carried out, with consecutive sampling during the study period. The data of 202 patients were obtained from the medical history to then perform the univariate and bivariate analysis with descriptive statistics. P value > 0,05 was considered significant. Results: there was an incidence of preoperative anxiety of 2,5%, arterial hypotension of 30,69% and bradycardia of 23,26%. There were no cases of postoperative vomiting, chills, or respiratory depression. Age was associated with preoperative anxiety (P = 0,03) and bradycardia (P= 0,049) but not with arterial hypotension (P = 0,066). Conclusions: master clonidine preparation is associated with low incidence of preoperative anxiety in children and absence postoperative respiratory vomiting, chills, and depression. However, there is concern about the high frequency of low blood pressure and bradycardia found without any association being raised..Au

Effects of Intramuscular Dexmedetomidine Versus Clonidine on the Duration of Subarachnoid Block and Analgesia for Lower Limb Orthopedic Surgeries

Background: Alpha-2adrenergic agonists, when used simultaneously as systemic adjuvants to local anesthetics show synergisticaction and improve the quality of spinal anesthesia and prolong the post-operative analgesia. We aimed to study the effects ofintramuscular dexmedetomidine versus clonidine on the duration of bupivacaine sub-arachnoid block, post-operative analgesia,and sedation in patients undergoing lower limb orthopedic surgeries.Materials and Methods: The study design was a prospective, randomized, and double-blind study. Eighty adult consentedpatients of ASA I or II, scheduled for orthopedic lower limb surgeries under spinal block were randomized to two groups of40 patients per group. Group D received IM dexmedetomidine 1 μgkg−1, Group C received IM clonidine 2 μgkg−1, and 30 minbefore the bupivacaine subarachnoid block. The time of onset of sensory and motor block, the time required for completesensory and motor recovery, time of the first request of rescue analgesia, and sedation levels were compared between thegroups. Collected data were analyzed using the student “t” test, Chi-square test/Fisher exact test, and P < 0.05 was consideredstatistically significant.Results: The mean onset time of sensory and motor block was reduced, the mean time required for complete sensory recoverywas increased and the time of the first request of rescue analgesia was prolonged in the dexmedetomidine group comparedto clonidine group with a significant P < 0.05. Ramsay sedation score was higher in the dexmedetomidine group compared toclonidine group (P = 0.003)Conclusion: Premedication with a single dose of intramuscular dexmedetomidine before bupivacaine spinal anesthesia actsas an effective adjuvant and potentiates the quality of block and prolongs post-operative analgesia more than intramuscularclonidine.

Comparative Analysis of the Efficacy of Epidural Dexmedetomidine and Clonidine with Bupivacaine in Patients Undergoing Infraumbilical Surgeries

Introduction: Pain was defined by Mountcastle in the year1968 as “that sensory experience evoked by stimuli thatinjures”. It is a subjective feeling and failure to relieve pain inany procedure cannot be accepted, both ethically and morally,and adequate pain relief must be treated as basic human right.Pain relief both in peri-operative and post-operative period isthe crux of anaesthesia. The aim of the study was to evaluatethe efficacy of epidural Dexmedetomidine and Clonidine as anadjuvant to Bupivacaine in patients undergoing infraumbilicalsurgeries.Material and Methods: Seventy (70) patients aged 20-60years (ASA I-II) undergoing infraumbilical surgery wererandomly allocated to two groups- Group BD receivingepidurally 15ml Bupivacaine (0.5%) + Dexmedetomidine(1mg/kg) and Group BC receiving 15ml Bupivacaine (0.5%)+ Clonidine (1mg/kg). After securing I/V line, infusionstarted with R/L and under strict aseptic condition, patientswere administered epidural block via 18G Tuohy needlein the sitting or lateral position at L3-L4 intervertebralspace.Results: We observed that the time taken for the onset ofsensory block at T10 level, time for sensory block upto T6 andthe time taken for maximum motor block is less in Group BDcompared to Group BC. Regarding the post-operative block,the time to sensory two segment regression, time to sensoryregression to S1, time for recovery of motor block and timeto first rescue analgesia were more in Group BD compared toGroup BC. And the difference between the two groups weresignificant (p<0.001).Conclusion: On the basis of the findings of our present clinicalstudy, we can come to conclusion that Dexmedetomidine ismore effective epidural adjuvant compared to Clonidine inpatients undergoing infraumbilical surgery.

An Observational Comparative Study to Assess the Block Characteristics of Intrathecal Buprenorphine and Clonidine When Added to Bupivacaine for Orthopaedic Lower Limb Surgeries

Postoperative analgesia enables faster rehabilitation, improves the patient's level of satisfaction, and reduces hospital stay. Regional anaesthesia is the most common anaesthetic technique used for orthopaedic surgeries across the world. Adjuvants are often administered along with a local anaesthetic during spinal anaesthesia to prolong intraoperative and postoperative analgesia. The main objective of this study was to compare the effect of 60 mcg buprenorphine with that of 30 mcg clonidine when added to 3.2 ml bupivacaine with respect to onset and duration of sensory and motor block, maximum level of sensory block, duration of analgesia, and side effects if any.METHODSAfter obtaining institutional ethical committee clearance, a prospective observational study was conducted among 88 participants undergoing orthopaedic surgery of lower limb. Spinal anaesthesia was given, under aseptic precautions with 0.5% bupivacaine heavy 3.2 ml along with either 60 mcg buprenorphine (0.2 ml) or clonidine 30 mcg (0.2 ml). The buprenorphine receiving patients (n=44) were under group A and the clonidine receiving patients (n=44) were under group B. The heart rate, blood pressure, sensory block level, and duration of analgesia, were recorded.RESULTSAnalysis of the data shows that the use of clonidine significantly prolonged the duration of analgesia compared to buprenorphine. The incidence of hypotension, bradycardia, nausea and vomiting, etc. were similar in both groups.CONCLUSIONSUse of 30 mcg clonidine as an adjuvant in spinal anaesthesia provides significant prolongation of analgesia (mean duration of analgesia 190.5 minutes) compared to 60 mcg buprenorphine (mean duration of analgesia 157.5 minutes) without causing any increased incidence of adverse effects.

A Comparative Study of Oral Clonidine and Oral Midazolam as Premedicants for General Anaesthesia

Preanaesthetic medication should be effective and pleasant to be taken orally, have analgesic and non-emetic properties, should not impair cardiovascular stability or depress respiration and produce adequate sedation and anxiolysis. We wanted to compare the effectiveness of oral clonidine and oral midazolam as preanaesthetic medicants.METHODSAfter obtaining the institutional ethical committee clearance and written informed consent, 60 patients, selected for surgery under general anaesthesia were divided by computer generated randomization in Group C (n=30): received Tablet clonidine 150 mcg (0.15 mg) and Group M (n=30): received Tablet midazolam 7.5 mg. Noninvasive blood pressure (systolic, diastolic & mean), respiratory rate, heart rate, degree of sedation, degree of anxiolysis, were recorded at, just before the administration of the any study drug which was 90 minutes before to the induction of anaesthesia, just before to induction of anaesthesia, three minutes after the orotracheal intubation, every 10 minutes for 3 such readings, and three minutes after the orotracheal extubation, and were statistically analysed.RESULTSOral clonidine produced significant attenuation of systolic, diastolic & mean arterial pressure, and reduced respiratory rate, than oral midazolam. Oral midazolam was able to attenuate the pulse rate in a better way than oral clonidine. Oral clonidine produced significant sedation and anxiolysis in comparison to patients who receiving oral midazolam.CONCLUSIONSOral clonidine is the better attenuator amongst the two drugs studied as premedicants to attenuate the cardiovascular responses to laryngoscopy and intubation.

Comparison of Intrathecal Clonidine and Fentanyl as Adjuvant to Hyperbaric Bupivacaine in Spinal Anaesthesia for Lower Limb Orthopedic Surgery: An Hospital Based Study

Background: There are various adjuvant used with hyperbaricbupivacaine to prolong the effect of spinal anesthesia butcommonly used fentanyl and clonidine. The present study wasundertaken to compare clonidine and fentanyl as adjuvant inspinal anesthesia in terms of time to onset of sensory andmotor blockade, duration of sensory and motor blockade andduration of postoperative analgesia and complications.Methods: The present study was undertaken in thedepartment of Anaesthesia, Government Medical College,Barmer, Rajasthan, India with primary aim to compare durationof postoperative analgesia. A total of 80 patients were enrolledin the present study. Ethical approval was obtained frominstitutional ethical committee and written consent wasobtained from all the patients. Complete demographic details ofall the patients were obtained. All the results were recorded inMicrosoft excel sheet and were analyzed by SPSS software.Results: In our study we found that time for first dose ofrescue analgesic was delayed in Group C (492.32 ± 17.32min) compared to Group F (418.80 ± 19.68min) which wasstatistically significant (P < 0.0001). Duration of sensory blockin Group C was 146.17 ± 19.42 min compared to 128.24 ±18.68min in Group F and Duration of motor block was 190.12 ±25.13 min in Group C in comparison to 176.18 ± 23.54 min in.

Espironolactona ou clonidina como quarto fármaco na hipertensão resistente? / Spironolactone or clonidine as the fourth drug to treat resistant hypertension?

A hipertensão arterial resistente (HAR) é definida como a ausência de controle pressórico nas medidas de pressão arterial (PA) de consultório a despeito do uso de três ou mais anti-hipertensivos em doses adequadas, incluindo-se preferencialmente um diurético, ou o controle pressórico atingido às custas do uso de quatro ou mais medicamentos. O uso de espironolactona, um antagonista dos receptores de aldosterona, como quarto fármaco no tratamento da HAR é indicado pelas principais diretrizes sobre o assunto, e tem a sua eficácia comprovada em ensaios clínicos e meta análises. Um estudo comparou o uso de clonidina, um agonista adrenérgico alfa-2, como quarto fármaco para tratamento da HAR em comparação com a espironolactona. Embora o desfecho primário (taxa de controle da PA no consultório ou na medida ambulatorial da PA) tenha sido similar com as duas medicações, a espironolactona mostrou maior redução na PA de 24h quando comparada à clonidina. Neste contexto, a clonidina pode ser uma alternativa à espironolactona, particularmente em grupos específicos de pacientes que tenham contraindicação ao uso de espironolactona, como os que apresentam hipercalemia ou doença renal crônica pré dialítica.

Resistant Hypertension (RH) is defined as the absence of blood pressure (BP) control despite the use of three antihypertensive drugs in adequate doses, or the achievement of BP control with the use of four or more medications. The use of spironolactone, an antagonist of aldosterone receptors, as the fourth medication in the treatment of RH is recommended by current Management of Hypertension Guidelines, and its efficacy has been proved in clinical trials and meta-analysis. One clinical trial compared the use of clonidine, an adrenergic alpha-2 agonist, versus spironolactone as an option as the fourth drug in the treatment of RH. The results showed similar rates of the primary outcome (BP control at the office and at ambulatory monitoring) with both drugs, although spironolactone promoted greater reduction in 24h BP when compared with clonidine. In this context, clonidine can be used as an alternative to spironolactone, particularly among specific groups of patients that have contraindications to the use of spironolactone, such as patients with hyperkalemia or end stage renal disease.