Clonidine-stimulated growth hormone concentrations (cut-off values) measured by immunochemiluminescent assay (ICMA) in children and adolescents with short stature

OBJECTIVES: To establish cut-off values for growth hormone concentrations using clonidine as a secretagogue and an immunochemiluminescent assay as the method of measurement and to analyze the response time as well as the influence of gender, nutritional status and pubertal stage. METHODS: A total of 225 tests were performed in 3 patient groups, categorized as group 1 (normal), group 2 (idiopathic short stature) and group 3 (growth hormone deficiency). Among the 199 disease-free individuals, 138 were prepubertal, and 61 were pubertal. Clonidine (0.1 mg/m2) was orally administered, and the growth hormone level was measured by immunochemiluminescent assay. The growth hormone peak and the difference between the growth hormone peak and the baseline level were then analyzed. Statistical analyses were performed using Student’s t-test or the Mann-Whitney test and Kruskal-Wallis test followed by Dunn’s post hoc test. Cut-off values were determined using a receiver operating characteristic curve. RESULTS: Group 1 and group 2 had no difference in growth hormone peak, gender, body mass index standard deviation score, or pubertal stage. Group 3 exhibited a significantly lower growth hormone peak than the other groups did. The receiver operating characteristic curve demonstrated that growth hormone concentrations ≥ 3.0 ng/mL defined responsiveness to clonidine. In total, 3.02% of individuals in group 1 and group 2 were considered false positive, i.e., these children lacked growth hormone deficiency and had a peak below 3.0 ng/mL. CONCLUSION: Clonidine-stimulated growth hormone concentrations ≥3 ng/mL, as measured by immunochemiluminescent assay, suggest responsiveness to the stimulus regardless of gender, body mass index standard deviation score or pubertal stage.

Administracao de clonidina intravenosa e sua capacidade de reduzir a pressao da arteria pulmonar em pacientes submetidos a cirurgia cardiaca / Intravenous clonidine administration and its ability to reduce pulmonary arterial pressure in patients undergoing heart surgery / Administracion de la clonidina intravenosa y su capacidad de reducir la presion de la arteria pulmonar en pacientes sometidos a cirugia cardiaca

Objetivo: Avaliar a capacidade da clonidina de reduzir a pressão arterial pulmonar de pacientes com hipertensão pulmonar, submetidos a cirurgia cardíaca, seja pela diminuição dos valores pressóricos a partir da aferição direta da pressão de artéria pulmonar, seja pela redução ouabolição da necessidade de dobutamina e nitroprussiato de sódio no intraoperatório. Método: Trata-se de estudo controlado, comparativo, randomizado e duplamente encoberto feito com 30 pacientes portadores de hipertensão arterial pulmonar tipo 2, submetidos a cirurgia cardíaca. Avaliaram-se a pressão média de artéria pulmonar e a posologia de dobutaminae nitroprussiato de sódio em quatro momentos: (M0) antes da administração de 2 µg/kg declonidina intravenosa ou placebo; (M1) decorridos 30 minutos do tratamento testado e antes da circulação extracorpórea; (M2) imediatamente após a circulação extracorpórea; e (M3)10 minutos após a injeção de protamina. Resultados: Não houve diferenças significativas em relação à pressão média de artéria pulmonarem nenhum dos momentos estudados. Entre os grupos não houve também diferença significativa entre as demais variáveis estudadas, como pressão arterial sistêmica média, frequência cardíaca, dosagem total de dobutamina, dosagem total de nitroprussiato de sódio e necessidade do hipnoanalgésico fentanil. Conclusão: A análise dos dados obtidos dos pacientes incluídos neste estudo permite concluir que a clonidina, na dose de 2 µg/kg administrada via intravenosa, não foi capaz de reduzir a pressão média de artéria pulmonar de pacientes com hipertensão pulmonar do grupo 2 (hipertensão venosa pulmonar), ...

Objective: Evaluate the ability of clonidine to reduce pulmonary arterial pressure in patients with pulmonary hypertension undergoing heart surgery, either by reducing the pressure values from the direct measurement of pulmonary arterial pressure or by reducing or eliminating the need for intraoperative dobutamine and nitroprusside. Method: Randomized, double-blind, placebo-controlled, comparative study conducted in 30 patients with pulmonary arterial hypertension type 2 undergoing cardiac surgery. Mean pulmonary arterial pressure and dosage of dobutamine and sodium nitroprusside were assessed four times: before intravenous administration of clonidine (2 µg/kg) or placebo (T0), 30 min after tested treatment and before cardiopulmonary bypass (T1), immediately after CPB (T2), 10 min after protamine injection (T3). Results: There were no significant differences regarding mean pulmonary arterial pressure at any time of evaluation. There was no significant difference between groups regarding other variables, such as mean systemic arterial pressure, heart rate, total dose of dobutamine, total dose of sodium nitroprusside, and need for fentanyl. Conclusion: Data analysis from patients included in this study allows us to conclude that intra-venous clonidine (2 µg/kg) was not able to reduce the mean pulmonary arterial pressure inpatients with pulmonary hypertension in group 2 (pulmonary venous hypertension), undergoing heart surgery, or reduce or eliminate the need for intraoperative administration of dobutamineand sodium nitroprusside. .

Objetivo: Evaluar la capacidad de la clonidina de reducir la presión arterial pulmonar de pacientes con hipertensión pulmonar sometidos a cirugía cardíaca, sea por la disminución de los valores tensionales a partir de la comprobación directa de la presión de la arteria pulmonar, o por la reducción o supresión de la necesidad de dobutamina y nitroprusiato de sodio en el intraoperatorio. Método: Se trata de un estudio controlado, comparativo, aleatorizado y doble ciego hecho con 30 pacientes con hipertensión arterial pulmonar tipo 2, sometidos a cirugía cardíaca. Fueron evaluados la presión promedio de la arteria pulmonar y la posología de dobutamina y nitroprusiato de sodio en 4 momentos: (M0) antes de la administración de 2 µg/kg de clonidina intravenosa o placebo; (M1) transcurridos 30 min del tratamiento testado y antes de la circulación extracorpórea; (M2) inmediatamente después de la circulación extracorpórea; y (M3) 10 min después de la inyección de protamina. Resultados: No fueron verificadas diferencias significativas con relación a la presión promedio de la arteria pulmonar en ninguno de los momentos estudiados. Entre los grupos tampoco hubo diferencia significativa entre las demás variables estudiadas, como presión arterial sistémica promedio, frecuencia cardíaca, dosificación total de dobutamina, dosificación total de nitroprusiato de sodio y la necesidad del hipnoanalgésico fentanilo. Conclusiones: El análisis de los datos obtenidos de los pacientes incluidos en este estudio permite concluir que la clonidina en una dosis de 2 µg/kg administrada por vía intravenosa no fue capaz de reducir la presión promedio de la arteria pulmonar de pacientes con hipertensión pulmonar del grupo 2 (hipertensión venosa pulmonar), sometidos ...

Comparison of efficacy of thioridazine with clonidine acting through different mechanisms in acute opioid abstinence syndrome

To compare the efficacy, safety and tolerability of thioridazine with clonidine in patients with Acute opioid Abstinence Syndrome. This single blind comparative clinical trial was carried out at Department of Pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Center [JPMC], Karachi. Fifty two addicts were selected randomly and were grouped into, group-A to received thioridazine 100 mg/day and group -B to received clonidine 150mcg/day. All participants completed the treatment program and stayed in hospital for ten days. The efficacy safety and tolerability of thioridazine was scant, while clonidine showed statistically significant turn down in the objective signs of acute opioid abstinence syndrome. Clonidine had more powerful effects than thioridazine. While treating the withdrawal signs of opioid abstinence syndrome may possibly pointed out that over activation of norepinephrine is a major factor contributes to the commencement of opioid abstinence syndrome

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes / Spinal anesthesia for cesarean section. Use of hyperbaric bupivacaine (10 mg) combined with different adjuvants / Raquianestesia en operación por cesárea. Uso de la asociación de bupivacaina hiperbárica (10 mg) a diferentes adyuvantes

JUSTIFICATIVA E OBJETIVOS: A associação de anestésicos locais (AL) a adjuvantes por via subaracnóidea melhora a qualidade do bloqueio e prolonga a duração da analgesia. Foram avaliados os efeitos maternos e as repercussões neonatais da associação de sufentanil, morfina e clonidina à bupivacaína hiperbárica em cesariana eletiva. MÉTODO: Estudo prospectivo, randomizado, encoberto, com 96 pacientes distribuídas em quatro grupos: GI (sem adjuvante); GII (sufentanil; 5,0 µg); GIII (morfina; 100 µg); e GIV (clonidina; 75 µg). Foram avaliados: início e nível de bloqueio sensitivo; analgesia peroperatória; grau e tempo para regressão do bloqueio motor; duração da analgesia; sedação; repercussões materno-fetais. RESULTADOS: O início do bloqueio foi significativamente menor nos grupos com adjuvantes em comparação com o Grupo I. No peroperatório, pacientes dos Grupos I e III referiram dor. A duração da analgesia foi significativamente maior no Grupo II e o tempo para desbloqueio motor foi significativamente maior no Grupo IV. Prurido ocorreu nos grupos II e III. A sedação foi significativa no Grupo IV. A hipotensão arterial foi prolongada no Grupo IV. CONCLUSÃO: A adição de sufentanil e clonidina à bupivacaína hiperbárica proporcionou adequada anestesia para cesariana e boa analgesia pós-operatória. A clonidina causou mais sedação peroperatória e maior tempo para desbloqueio motor. O prurido foi evidente quando do emprego de opioides.

BACKGROUND AND OBJECTIVES: Combination of local anesthetics (LA) with adjuvants for spinal anesthesia improves block quality and prolongs the duration of analgesia. It was evaluated the maternal effects and neonatal repercussions of sufentanil, morphine, and clonidine combined with hyperbaric bupivacaine for elective cesarean section. METHOD: Prospective, randomized, blinded study of 96 patients allocated into four groups: Group I (no adjuvant), Group II (sufentanil 5.0 µg), Group III (morphine 100 µg), and Group IV (clonidine 75 µg). It was evaluated the onset and level of sensory block, perioperative analgesia, degree and recovery time of motor block, duration of analgesia, sedation, and maternal-fetal repercussions. RESULTS: The onset of blockade was significantly faster in groups with adjuvants compared with Group I. Patients in Groups I and III reported pain during the perioperative period. Duration of analgesia was significantly higher in Group II and time to motor block recovery was significantly higher in Group IV. Pruritus occurred in Groups II and III. Sedation was significant in Group IV and there was prolonged arterial hypotension in Group IV. CONCLUSION: Addition of sufentanil and clonidine to hyperbaric bupivacaine provided adequate anesthesia for cesarean section and good postoperative analgesia. Clonidine caused more perioperative sedation and longer time to motor block recovery. Pruritus was evident when opioids were used.

JUSTIFICATIVA Y OBJETIVOS: La asociación de anestésicos locales (AL) a adyuvantes por vía subaracnoidea mejora la calidad del bloqueo y prolonga la duración de la analgesia. Se evaluaron los efectos maternos y las repercusiones neonatales de la asociación de sufentanil, morfina y clonidina a la bupivacaina hiperbárica en la cesárea electiva. MÉTODO: Estudio prospectivo, randomizado, encubierto, con 96 pacientes distribuidas en cuatro grupos: GI (sin adyuvante); GII (sufentanil; 5,0 µg); GIII (morfina; 100 µg); y GIV (clonidina; 75 µg). Se evaluaron: el inicio y el nivel de bloqueo sensitivo; analgesia peroperatoria; el grado y el tiempo para la regresión del bloqueo motor; la duración de la analgesia; la sedación; y las repercusiones materno-fetales. RESULTADOS: El inicio del bloqueo fue significativamente menor en los grupos con adyuvantes en comparación con el Grupo I. En el perioperatorio, los pacientes de los Grupos I y III dijeron sentir dolor. La duración de la analgesia fue significativamente mayor en el Grupo II y el tiempo para el desbloqueo motor fue significativamente mayor en el Grupo IV. El prurito apareció en los grupos II y III. La sedación fue significativa en el Grupo IV. La hipotensión arterial se prolongó en el Grupo IV. CONCLUSIONES: La adición de sufentanil y clonidina a la bupivacaina hiperbárica proporcionó una adecuada anestesia para la cesárea como también una buena analgesia postoperatoria. La clonidina causó más sedación perioperatoria y un mayor tiempo para el desbloqueo motor. El prurito fue evidente cuando se usaron los opioides.

[Evaluation of oral clonidine effects on prevention of post-anesthesia shivering]

Shivering is a common post anesthesia complication. Intravenous Clonidine administration at induction of anesthesia is a useful drug for decreasing of incidence and severity of post-anesthesia shivering. As Clonidine injection can induce side effects therefore we evaluated the oral Clonidine premedication on post-anesthesia shivering. In a RCT, 60 adult patients in ASA class 1 and 2 scheduled for cholecystectomy were assigned to 2 groups. 2 hours before anesthesia, 0.2 mg oral Clonidine was administrated and to the other group placebo was administered. Surgery room temperature was adjusted for 21-23[degree][c]. At the end of the anesthesia, the patients' shivering was evaluated in the recovery room by "Crossley andMahajan shivering score". There was no difference at decrease of SpO2 and H.R. and MAP between 2 groups. There was no difference in average time of emergence between 2 groups. Overall 75% of the patients shivered after anesthesia. Median shivering score in clonidine group was 1.97 and in placebo were 2.87. It became revealed that there was clear difference at shivering score between 2 groups [less severe or generalized shivering patients in test group]. 0.2 mg Clonidine tablet, 2 hours before anesthesia is similar to injecting drug and is effective in prevention of post-anesthesia shivering but its complication is less. Lack of difference at hemodynamics and SpO2 and emergence in our study may be due to slow absorption of oral Clonidine

Modulation of WIN55, 212-2 state-dependent memory by alpha2-adrenergic receptors of the dorsal hippocampus

An overlapping distribution of alpha2-adrenergic receptors with cannabinoid receptors has been reported in certain brain structures such as the dorsal hippocampus. Thus, functional interactions between cannabinoid and alpha2-adrenergic systems in cognitive control seem possible. In the present study, we examine the possible role of alpha2-adrenergic receptors of the dorsal hippocampus on WIN55.212-2 state-dependent learning. Adult male Wistar rats were bilaterally implanted with chronic cannulae in the CA1 regions of their dorsal hippocampi trained in a step-down type inhibitory avoidance task and tested 24 hr after training, to measure step-down latency. Post-training or pre-test intra-CA1 administration of the cannabinoid receptor agonist, WIN 55,212-2 [0.25 and 0.5microg/rat] induced amnesia. Amnesia produced by post-training WIN55,212-2 [0.5 microg/rat] was reversed by pre-test administration of WIN55,212-2, that was due to a state-dependent effect. Pre-test intra-CA1 microinjections of clonidine [0.25, 0.5 and 1 microg/rat] or yohimbine [0.5, 0.75, and 1 MQ/rat] did not affect memory retrieval per se. Pre-test intra-CA1 administration of clonidine [0.5 and 1 micro9/rat] or clonidine [0.25, 0.5, and 1 microg/rat] with an ineffective dose of WIN 55,212-2 [0.25 microg/rat] reversed post-training WIN55,212-2 [0.5 microg/rat,intra-CA1] induced memory impairment. Pre-test intra-CA1 microinjection of yohimbine [1 microg/rat] before administration of WIN55,212-2 [0.5 microg/rat, intra-CA1], however, dose-dependently inhibited WIN55.212-2 state-dependent memory. Modulation of a2-adrenergic receptors in the dorsal hippocampal CA1 regions can influence WIN55, 212-2 induced amnesia and WIN55,212-2 state-dependent learning of an inhibitory avoidance task by pre- or post-synaptic mechanism[s]

Role of clonidine in perioperative acute atrial fibrillation

We report a case of acute onset atrial fibrillation [AF] that presented for emergency surgery where rate control and sinus rhythm were successfully achieved using clonidine. Patient had acute AF with high blood pressure. Metoprolol failed to decrease the ventricular rate and blood pressure but with clonidine, we could achieve both the goals. Also, rhythm reverted to a sinus rhythm and continued to be in sinus rhythm after administering clonidine

Attenuation of hemodynamic responses following laryngoscopy and tracheal intubation

The present study was conducted to compare the effect of clonidine and gabapentin premedication in modifying the hyperdynamic response following laryngoscopy and tracheal intubation. Seventy-five ASA I-II patients of both sexes [37 males [49.3%], 38 females [50.7%]] 18 to 45 years [mean 32.8 +/- 8.65yr.] were randomly allocated into three equal groups [25 each]. Group-1 received 0.2 mg clonidine, Group-2 received placebo and Group-3 received 900 mg gabapentin, 120 minute before operation. Heart rate, systolic, diastolic and mean arterial blood pressure were measured before induction of anesthesia, before laryngoscopy, and 1, 3, 5, 10 min after intubation. Analysis revealed that the heart rate, systolic, diastolic and mean arterial blood pressure significantly differed between groups [p < 0.001, p = 0.003, p < 0.001, p < 0.001, respectively]. The highest rates of heart rate, systolic, diastolic and mean arterial blood pressure were in the placebo group and in one minute after laryngoscopy, and the lowest rate were in the gabapentin group at the time of 1, 3, 5 and 10 after laryngoscopy, except that the lowest rate of heart rate in 10 min after laryngoscopy was in clonidine group. The data propose that both clonidine and gabapentin have effective role in blunting hyperdynamic responses after laryngoscopy, more so with gabapentin

Efeito da adição de clonidina subaracnóidea à solução anestésica de sufentanil e bupivacaína hiperbárica ou hipobárica para analgesia de parto / Efecto de la adición de clonidina subaracnoidea a la solución anestésica de sufentanil y bupivacaína hiperbárica o hipobárica para la analgesia de parto / Effects of the addition of subarachnoid clonidine to the anesthetic solution of sufentanil and hyperbaric or hypobaric bupivacaine for labor analgesia

JUSTIFICATIVA E OBJETIVOS: Adição de clonidina subaracnóidea (±-agonista) prolonga a ação analgésica da combinação sufentanil e bupivacaína isobárica em analgesia combinada para o trabalho de parto Õ. O objetivo deste estudo foi comparar a qualidade de analgesia e a prevalência de efeitos colaterais após a adição de clonidina subaracnóidea à solução anestésica em gestantes durante trabalho de parto. MÉTODO: Após aprovação da Comissão de Ética, 22 gestantes em trabalho de parto receberam aleatoriamente no espaço subaracnóideo 2,5 mg de bupivacaína hiperbárica 0,5 por cento (grupo CLON/HIPER; n = 11) ou 2,5 mg de bupivacaína isobárica 0,5 por cento (grupo CLON/ISO; n = 11) em associação ao sufentanil 2,5 µg e à clonidina 30 µg. A dor avaliada pela Escala Analógica Visual, a freqüência cardíaca e a pressão arterial média foram estudadas a cada 5 minutos nos primeiros 15 minutos e, a seguir, a cada 15 minutos até o nascimento. Foi avaliada a prevalência de efeitos colaterais (náusea, vômito, prurido e sedação). O estudo foi encerrado no momento em que foi necessária complementação analgésica peridural (dor > 3 cm) ou ao nascimento. A análise estatística foi realizada pelos testes t de Student, Qui-quadrado, Fisher e ANOVA de duas vias para medidas repetidas, considerando como significativo p < 0,05. RESULTADOS: Os grupos CLON/HIPER e CLON/ISO foram semelhantes com relação a dados antropométricos, duração da analgesia (70,9 ± 32,9 vs. 85,4 ± 39,5), freqüência cardíaca, ocorrência de prurido, sedação, náusea e vômitos. No grupo CLON/ISO houve diminuição significativa da pressão arterial média com relação ao grupo CLON/HIPER nos momentos 15, 30 e 45 minutos (p < 0,05). CONCLUSÕES: Nas condições estudadas, a adição de clonidina em baixa dose (30 »g), associada ao sufentanil, determinou maior ocorrência de hipotensão quando administrada com soluções isobáricas de anestésico local. Com relação aos demais efeitos colaterais, as soluções hiperbáricas...

BACKGROUND AND OBJECTIVES: The addition of subarachnoid clonidine (α-agonist) prolongs the analgesia produced by the combination of sufentanil and isobaric bupivacaine in combined labor analgesiaÕ. The objective of this study was to compare the quality of analgesia and the prevalence of side effects after the addition of subarachnoid clonidine to the anesthetic solution in labor analgesia. METHODS: After approval by the Ethics Commission, 22 pregnant women in labor were randomly assigned to the subarachnoid administration of either 2.5 mg of 0.5 percent hyperbaric bupivacaine (CLON/HYPER Group; n = 11) or 2.5 mg of 0.5 percent isobaric bupivacaine (CLON/ISO Group; n = 11) associated with 2.5 µg of sufentanil and 30 µg of clonidine. Pain, evaluated by the Visual Analogue Scale, heart rate, and mean arterial pressure were assessed every 5 minutes during the first 15 minutes, and then every 15 minutes afterwards until delivery. The prevalence of side effects (nausea, vomiting, pruritus, and sedation) was evaluated. The study was terminated whenever the patient needed supplemental epidural analgesia (pain > 3) or upon delivery of the fetus. The Student t test, Chi-square test, Fisher exact test, and two-way ANOVA for repeated measurements were used in the statistical analysis and a p < 0.05 was considered significant. RESULTS: Anthropometric data, duration of analgesia (70.9 ± 32.9 vs. 85.4 ± 39.5), heart rate, and the incidence of pruritus, sedation, nausea, and vomiting were similar in both groups. Mean arterial pressure was significantly lower in the CLON/ISO Group than in the CLON/HYPER Group at 15, 30, and 45 minutes (p < 0.05). CONCLUSIONS: Under the conditions of the present study, the association of a small dose of clonidine (30 µg) with sufentanil caused a higher incidence of hypotension when the isobaric solution of the local anesthetic was used. For all other side effects, both hyperbaric and isobaric solutions...

JUSTIFICATIVA Y OBJETIVOS: La adición de la clonidina subaracnoidea (±-agonista), prolonga la acción analgésica de la combinación sufentanil y bupivacaína isobárica en analgesia combinada para el trabajo de parto Õ. El objetivo de este estudio fue comparar la calidad de analgesia y la prevalencia de los efectos colaterales, después de la adición de clonidina subaracnoidea a la solución anestésica en gestantes durante el parto. MÉTODO: Después de la aprobación de la Comisión de Ética, 22 gestantes en trabajo de parto recibieron aleatoriamente en el espacio subaracnoideo 2,5 mg de bupivacaína hiperbárica 0,5 por ciento (grupo CLON/HIPER; n = 11) o 2,5 mg de bupivacaína isobárica 0,5 por ciento (grupo CLON/ISO; n = 11) en asociación con el sufentanil 2,5 µg y la clonidina 30 µg. El dolor evaluado por la Escala Analógica Visual, la frecuencia cardíaca y la presión arterial promedio, fueron estudiados a cada 5 minutos en los primeros 15 minutos y a continuación, a cada 15 minutos hasta el nacimiento. Fue evaluada la prevalencia de efectos colaterales (náusea, vómito, prurito y sedación). El estudio fue terminado en el momento en que se hizo necesaria la complementación analgésica epidural (dolor > 3 cm) o al nacimiento. El análisis estadístico fue realizado a través de los tests t de Student, Chi-cuadrado, Fisher y ANOVA de dos vías para medidas repetidas, considerando como significativo p < 0,05. RESULTADOS: Los grupos CLON/HIPER y CLON/ISO fueron similares con relación a los datos antropométricos, duración de la analgesia (70,9 ± 32,9 vs. 85,4 ± 39,5), frecuencia cardíaca, incidencia de prurito, sedación, náusea y vómitos. En el grupo CLON/ISO hubo una disminución significativa de la presión arterial promedio con relación al grupo CLON/HIPER en los momentos 15, 30, y 45 minutos (p < 0,05). CONCLUSIONES: En las condiciones estudiadas, la adición de clonidina en baja dosis (30 »g), asociada al sufentanil, determinó una mayor incidencia de...

Effects of clonidine on the hemodynamic changes of electroconvulsive therapy

Electroconvulsive therapy [ECT] is an effective treatment for many psychological disorders, mainly major depression and schizophrenia which is often associated with some complications such as hypertension, tachycardia arrhythmia and even myocardial infarction. Various methods have been used for prevention or control of these cardiovascular side effects. The aim of this study was evaluating the effect of oral clonidine as premedication on hemodynamic response after ECT. This double-blind clinical trial was performed on 100 patients aged 15-50 years with ASA I and II who were candidates for ECT. Prior to ECT, patients were randomly divided to 2 equal groups. The first group [N=50] received oral clonidine and the second group [N=50] received placebo as premedication. After baseline measurement of heart rate, systolic and diastolic blood pressures, similar induction of anesthesia was done in both groups. Then ECT was induced. The patients heart rate, systolic and diastolic blood pressure were measured again 2 minutes after termination of convulsion. Data was analyzed by t-test p<0.05 was considered statistically significant. Regarding age, sex and baseline hemodynamic parameters, the patients were similar in both groups. Mean systolic and diastolic blood pressures after ECT were significantly lower in clonidine group [p<0.05], but there was no significant difference between heart rate after ECT in the two groups. According to these results, we recommend usage of clonidine as premedication before ECT

Sedative and cardiovascular effects of midazolam and diazepam alone or combined with clonidine in patients undergoing hemodynamic studies for suspected coronary artery disease / Efeitos sedativos e cardiovasculares do midazolam e do diazepam, associados ou não a clonidina, em pacientes submetidos a estudos hemodinâmicos por suspeita de doença arterial coronariana

FUNDAMENTO: A sedação durante a cineangiocoronariografia tem sido pouco estudada e saber qual é a melhor droga para sedar esses pacientes é um questionamento importante. OBJETIVO: Avaliar a qualidade da sedação e os efeitos sobre a freqüência cardíaca (FC) e a pressão arterial (PA) do midazolam e do diazepam, associados ou não a clonidina, em pacientes com suspeita de doença coronariana. MÉTODOS: Foi desenvolvido ensaio clínico prospectivo, duplo-cego, randomizado, controlado, com 160 pacientes divididos em cinco grupos de 32 pacientes cada, de acordo com o fármaco utilizado: grupo C (clonidina 0,5 µg/kg); grupo M (midazolam 40 µg/kg); grupo MC (associação de midazolam 40 µg/kg e clonidina 0,5 µg/kg); grupo D (diazepam 40 µg.kg); e grupo DC (associação de diazepam 40 µg/kg e clonidina 0,5 µg/kg). A sedação foi avaliada com base na escala de Ramsay e no consumo de meperidina 0,04 mg.kg-1. A PA invasiva, a FC e o escore de sedação foram analisados a cada cinco minutos em quatro diferentes momentos. RESULTADOS: Os pacientes que utilizaram midazolam apresentaram maiores escores de sedação e variação da FC e da PA (p < 0,05). Os que utilizaram diazepam ou clonidina tiveram menores escores de sedação e mais satisfatórios para a realização do exame e apresentaram menor variação da PA e da FC (p > 0,05). CONCLUSÃO: O midazolam foi associado a maior efeito sedativo e cardiovascular enquanto o diazepam causou menor efeito sedativo e cardiovascular. A clonidina e o diazepam tiveram efeitos semelhantes na PA, na FC e na sedação.

BACKGROUND: Sedation during coronary angiography has been rarely studied, and it is important to know which drug is the best to sedate these patients. OBJECTIVE: To evaluate the quality of sedation and the effects of midazolam and diazepam alone or combined with clonidine on the heart rate (HR) and blood pressure (BP) of patients with suspected coronary artery disease. METHODS: This is a controlled, randomized, double-blind, prospective clinical study of 160 patients divided into five groups of 32 patients each, according to the drug used: group C (clonidine 0.5 µg/kg); group M (midazolam 40 µg/kg); group MC (combination of midazolam 40 µg/kg and clonidine 0.5 µg/kg); group D (diazepam 40 µg/kg); and group DC (combination of diazepam 40 µg/kg and clonidine 0.5 µg/kg). Sedation was evaluated based on the Ramsay scale and on the use of meperidine 0.04 mg.kg-1. Invasive BP monitoring, HR and the sedation score were analyzed every five minutes at four different time points. RESULTS: Patients who received midazolam presented higher sedation scores as well as HR and BP variation (p < 0.05). Those who received diazepam or clonidine had lower sedation scores, which were more satisfactory for the performance of the procedure, and presented a lower BP and HR variation (p > 0.05). CONCLUSION: Midazolam was associated with a greater sedative and cardiovascular effect, whereas for diazepam these effects were less intense. Clonidine and diazepam had similar effects on BP, HR and sedation.

Prolongation of action of bupivacaine in caudal block in pediatrics: comparative study between addition of ketamine, clonidine and adrenaline

Regional anesthesia is considered an effective method for providing analgesia both intraoperatively and postoperatively and also decreases the total amount of general anesthesia required for surgery, provides more rapid recovery and faster wake up times. Caudal block is the most useful and common pediatric regional block as it is widely applicable and technically simple. Many factors influence the activity of caudally administrated local anesthetic solutions as dosage, addition of a vasoconstrictor e.g. epinephrine and addition of drugs as Ketamine and Clonidine. In this study, we compared the analgesic efficacy and side effects of Bupivacaine alone, Bupivacaine + Epinephrine, Bupivacaine + Clonidine and Bupivacaine + Ketamine. In the current study the addition of drugs to Bupivacaine has significantly extended the duration of caudal analgesia more than Bupivacaine alone especially with Ketamine and Clonidine

Clonidina na cineangiocoronariografia: efeitos sedativos sobre a pressão arterial e freqüência cardíaca / Clonidine in cineangiocardiography: sedative effects on blood pressure and heart rate

OBJETIVO: Avaliar os efeitos da clonidina sobre a freqüência cardíaca (FC), pressão arterial (PA) e sedação de pacientes submetidos à cineangiocoronariografia. MÉTODOS: Um ensaio clínico prospectivo, duplo cego, randomizado, controlado, foi realizado com 62 pacientes submetidos a cineangiocoronariografias eletivas, divididos em dois grupos: grupo clonidina que utilizou 0,8 æg/kg desta droga, e o grupo controle que utilizou solução fisiológica a 0,9 por cento. A sedação foi avaliada com base na escala de Ramsay e o consumo de meperidina 0,04 mg/kg que foi utilizada nos pacientes que apresentaram agitação ou ansiedade durante o procedimento. A PA invasiva, a FC e o escore de sedação, de acordo com a escala de Ramsay, foram analisados a cada 5 minutos e quatro diferentes momentos foram considerados para avaliação: M1- inicio do exame; M2- 5 minutos após o início do exame; M3- mediana do tempo do exame e M4 - final do exame. RESULTADOS: O grupo clonidina apresentou maior estabilidade da PA e FC e eficácia na sedação, enquanto o grupo controle apresentou um maior consumo de meperidina (p<0,05). Na análise estatística, para inferência das variáveis contínuas foi utilizado o teste T ou Mann-Whitney e chi2 ou Teste Exato de Fisher para as variáveis categóricas. CONCLUSÃO: Este trabalho mostrou que, nos pacientes submetidos à cineangiocoronariografia, a utilização da clonidina foi eficaz tanto no controle da PA e FC quanto em proporcionar uma sedação consciente.

OBJECTIVE: To evaluate the effects of clonidine on heart rate (HR), and blood pressure (BP) as well as its sedative effect on patients submitted to a cineangiocardiography. METHODS: A randomized, controlled, double blind, prospective clinical trial was conducted on 62 patients submitted to an elective cineangiocardiography. The patients were divided in two groups: the clonidine group, that were administered a 0.8 æg/kg dose of this drug and the control group, that were administered a 0.9 percent saline solution. Sedation was evaluated based on the Ramsay Scale and the administration of a 0.04 mg/kg dose of meperidine that was given to the patients who were agitated or anxious during the procedure. The invasive BP, HR and sedation score based on the Ramsay Scale were analyzed every 5 minutes and four different intervals were considered for the assessment: I1- start of the test; I2- 5 minutes after the start of the test; I3- median time of the test and I4- end of the test. RESULTS: The clonidine group presented better BP and HR stability and sedation efficacy while the control group presented a higher intake of meperidine (p<0.05). In the statistical analysis, the inference of the continuous variables was calculated using the Student's t-test or Mann-Whitney test and the chi2 or Fisher Exact Probability test was used for the categorical variables. CONCLUSION: This study demonstrated that clonidine was an efficient means to control BP and HR and provided a conscious sedation for patients submitted to a cineangiocardiography.

Effect of Withania somnifera on forced swimming test induced immobility in mice and its interaction with various drugs.

The objective of the present study was to evaluate the antidepressant action of Withania somnifera (WS) as well as its interaction with the conventional antidepressant drugs and to delineate the possible mechanism of its antidepressant action using forced swimming model in mice. Effect of different doses of WS, fluoxetine and imipramine were studied on forced swimming test induced mean immobility time (MIT). Moreover effect of WS 100 mg/kg, i.p. was observed at different time intervals. Effect produced by combination of sub therapeutic doses of WS with imipramine (2.5 mg/kg, i.p.) as well as fluoxetine (2.5 mg/kg, i.p.) were also observed. Effect of WS (100 mg/kg, i.p.) as well as combination of WS (37.5 mg/kg, i.p.) with either imipramine (2.5 mg/kg, i.p.) or fluoxetine (2.5 mg/kg, i.p.) were observed in mice pretreated with reserpine (2 mg/kg, i.p.) and clonidine (0.15 mg/kg, i.p.). Effects of prazosin (3 mg/kg, i.p.) or haloperidol (0.1 mg/kg, i.p.) pre-treatment were also observed on WS induced decrease in MIT. WS produced dose dependent decrease in MIT. Maximum effect in MIT was observed after 30 min of treatment with WS 100 mg/kg, i.p. Combination of WS (37.5 mg/kg, i.p.) with imipramine (2.5 mg/kg, i.p.) or fluoxetine (2.5 mg/kg, i.p.) also produced significant decrease in the MIT. Clonidine and reserpine induced increase in MIT, was significantly reversed by treatment with WS (100 mg/kg, i.p.) as well as combination of WS (37.5 mg/kg, i.p.) with either imipramine (2.5 mg/kg, i.p.) or fluoxetine (2.5 mg/kg, i.p.). Pre-treatment with prazosin but not haloperidol, significantly antagonized the WS (100 mg/kg, i.p.) induced decrease in MIT. It is concluded that, WS produced significant decrease in MIT in mice which could be mediated partly through a adrenoceptor as well as alteration in the level of central biogenic amines.

Efeitos hemodinâmicos e renais da injeção de doses elevadas de clonidina no espaço peridural do cão / Hemodynamic and renal effects of high epidural clonidine doses in dogs

JUSTIFICATIVA E OBJETIVOS: Não existem estudos que relatem as repercussões renais determinadas pela injeção de doses elevadas de clonidina no espaço peridural. O objetivo do estudo foi avaliar os efeitos hemodinâmicos e renais determinados pela injeção de doses elevadas de clonidina no espaço peridural do cão. MÉTODO: Vinte animais anestesiados com tiopental sódico e fentanil foram distribuídos aleatoriamente e de forma duplamente encoberta em dois grupos: Grupo 1 ou placebo (n = 10), que recebeu 0,2 mL.kg-1 de solução fisiológica, e Grupo 2 ou clonidina (n = 10), que recebeu 0,2 mL.kg-1 de uma solução contendo 50 µg.mL-1 de clonidina, no espaço peridural. Foram avaliados os seguintes parâmetros hemodinâmicos: freqüência cardíaca (FC): bat.min-1; pressão arterial média (PAM): mmHg; pressão da artéria pulmonar ocluida (PAOP): mmHg; débito cardíaco (DC): L.min-1; volume sistólico (VS): mL; também, os seguintes parâmetros da função renal foram avaliados: fluxo sangüíneo renal (FSR): mL.min-1; resistência vascular renal (RVR): mmHg.mL-1.min; volume urinário minuto (VUM): mL.min-1; depuração de creatinina (D Cr): mL.min-1; depuração de para-aminohipurato (D PAH): mL.min-1; fração de filtração (FF); depuração de sódio (D Na): mL.min-1; depuração de potássio (D K): mL.min-1; excreção fracionária de sódio (EF Na): por cento; excreção urinária de sódio (U NaV): µEq.min-1; excreção urinária de potássio (U K V): µEq.min-1. O experimento consistiu em três momentos de 20 minutos cada. Os dados foram coletados aos 10 minutos de cada momento e a diurese, no início e no final de cada momento. Ao término de M1, a clonidina ou a solução fisiológica foi administrada no espaço peridural. Após período de 20 minutos iniciou-se M2 e, em seguida, M3. RESULTADOS: A clonidina na dose de 10 µg.kg-1 no espaço peridural do cão promoveu alterações significativas, com diminuições da freqüência cardíaca e do débito cardíaco e aumento da relação depuração de para-aminohipurato de sódio/débito cardíaco. CONCLUSÕES: Nas condições realizadas e nas doses empregadas, pode-se concluir que a clonidina não promoveu alteração da função renal, mas diminuiu valores hemodinâmicos (freqüência e débito cardíaco).

Oral clonidine premedication decreases intraoperative bleeding in patients undergoing endoscopic sinus surgery

The antihypertensive drug, clonidine, is a centrally acting alpha 2 agonist, useful as a premedication because of its sedative and analgesic properties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endoscopic sinus surgery. We also evaluated the relation between bleeding volume and consumption of fentanyl and hydralazine to control hypotension. This prospective double - blinded clinical trial was performed on 113 patients [ASA I, ASA II]. Fifty-two patients received oral clonidine [5 micro g/kg] while the other 61 patients received placebo. During general anesthesia, the hemodynamic endpoint of the anesthetic management was maintenance of hypotension [MAP] at 70 mmHg for producing a bloodless surgical field. The direct control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol% as needed. When it was unsuccessful, an intravenous fentanyl bolus of 2 micro g/kg was also added. When both drugs failed, hydralazine, was given intravenously as a bolus and intermittently, 0.1mg/kg up to a maximum dose of 40 mg. Intraoperative bleeding was assessed on a six - point scale from 0 [= no bleeding] to 5 [= severe bleeding]. Data were compared with chisquare test, fisher's exact test and Student t-test. There was less bleeding volume in the clonidine group [mean +/- SD] than in the placebo group [144 +/- 75 Vs 225 +/- 72 ml, P<0.05]. Frequency of bleeding severity scores 3 and 4 [troublesome with repeated suction] were lower in the clonidine group than in the placebo group [12% Vs 35%, P< 0.05]. Fentanyl requirement was significantly lower [112 +/- 18 Vs 142 +/- 21 micro g, P < 0.05] in the clonidine group. Hydralazine requirement was significantly lower [0.45 +/- 1.68 Vs 2.67 +/- 4.33 mg, P<0.05] as well. Premedication with oral clonidine reduces bleeding in endoscopic sinus surgery and also decreases fentanyl, and hydralazine consumption for controlling hypotension

Adrenergic involvement in the locus ceruleus and adjoining regions in the facilitation of predatory attack behavior as induced by hypothalamic stimulation in cats.

The present study was carried out in five cats which did not attack the rats spontaneously. Predatory attack on an anaesthetized rat was elicited by electrical stimulation of extreme lateral regions of hypothalamus. These sites were stimulated at a current strength from 300-700 microa to evoke a predatory attack on an anaesthetized rat. The attack was accompanied by minimal affective display such as alertness, pupillary dilatation, and culminated in beck biting at higher current strength. A scoring system allowed the construction of stimulus response curves, which remained fairly constant when repeated over a period of 3-4 weeks. Microinfusions of norepineprine and clonidine in 4.0 and 5.0 microg dose respectively in locus ceruleus and adjoining tegmental fields facilitated the predatory attack and there was a significant reduction in the threshold current strength for the elicitation of affective and somatomotor components. Microinfusions of yohimbine, an alpha-2 blocker, in 5 microg dose completely blocked the predatory attach response as indicated by an increase in the threshold current strength for the affective components. The somatomotor components were completely inhibited and could not be elicited even when the current strength was increased to 1000 microA. The predatory attack behavior remained completely inhibited for almost two hours following microinfusion of yohimbine. During this period, the animal was extremely drowsy and reacted very slowly even to a painful stimulus such as pinching of tail. Microinfusions of propranalol (beta-blocker), practalol (beta-1 blocker), prazosin (alpha-1 antagonist), propylene glycol as well as saline in similar volumes (0.5 microl) as control failed to produce any blocking effect, thus indicating the involvement of alpha-2 adrenoceptive mechanisms in the modulation of predatory attack in this region of midbrain. The facilitatory effects of norepinephrine and clonidine were significant at P<0.01 and P<0.05 respectively with Wilcoxon's signed rank test. The inhibitory effects of yohimbine were significant at P<0.05. The present study indicates the involvement of alpha-2 adrenoceptive mechanisms in the facilitation of hypothalamically elicited predatory attack.

Efeitos da clonidina nas respostas cardiovasculares ao pinçamento aórtico infra-renal: estudo experimental no cão / Effects of clonidine on cardiovascular responses to infrarenal aortic cross-clamping: experimental study in dogs

JUSTIFICATIVA E OBJETIVOS: O pinçamento aórtico infra-renal pode determinar alterações cardiovasculares. A clonidina, um alfa2-agonista, determina bradicardia e diminuição da pressão arterial. O objetivo do estudo foi avaliar os efeitos da clonidina sobre a função cardiovascular, em cães submetidos a pinçamento aórtico infra-renal. MÉTODO: O estudo aleatório foi realizado em 16 cães, distribuídos em dois grupos: G Controle - sem a utilização de clonidina e G Clon - clonidina, na dose inicial de 5 'g.kg-1, por via venosa, imediatamente antes do pinçamento aórtico infra-renal, seguido de 2 'g.min-1.m² até o final do estudo. Em todos os animais foi realizada ligadura infra-renal da aorta, por 45 minutos. Os atributos hemodinâmicos foram estudados nos momentos C (controle), após 10 (Ao10) e 25 (Ao25) minutos do pinçamento aórtico, e após 10 (DAo10) e 25 (DAo25) minutos do despinçamento aórtico. RESULTADOS: Durante o pinçamento aórtico, houve diferença significante entre os grupos, em relação à freqüência cardíaca, pressão arterial média e índice cardíaco (G Controle > G Clon). Após o despinçamento aórtico houve diferença significante entre os grupos, em relação à freqüência cardíaca (G Controle > G Clon) e pressões do átrio direito e da artéria pulmonar ocluída (G Clon > G Controle). Durante o pinçamento aórtico, houve nos dois grupos, aumento significante das pressões de átrio direito e artéria pulmonar ocluída, dos índices sistólico e do trabalho sistólico do ventrículo esquerdo, e diminuição do índice de resistência vascular pulmonar...

BACKGROUND AND OBJECTIVES: Infrarenal aortic cross-clamping is associated to cardiovascular effects. Clonidine, an a2-agonist, determines bradycardia and hypotension. This study aimed at analyzing the effects of clonidine on the cardiovascular function of dogs submitted to infrarenal aortic cross-clamping. METHODS: This randomized study involved 16 mixed breed dogs randomly distributed in two groups: G Control - no clonidine; and G Clon - clonidine (5 µg.kg-1) immediately before aortic cross-clamping, followed by 2 µg.min-1.m2 until the end of the study. All dogs were submitted to infrarenal aortic cross-clamping during 45 minutes. Hemodynamic parameters were measured at control (C), 10 (Ao10) and 25 (Ao25) minutes after aortic cross-clamping, and 10 (DAo10) and 25 (DAo25) minutes after aortic unclamping. RESULTS: There were significant differences between groups in heart rate, mean blood pressure and cardiac index (G control > G Clon) during aortic cross-clamping. After aortic unclamping there were significant differences between groups in heart rate (G Control > G Clon), and right atrium and pulmonary capillary wedge pressures (G Clon > G Control). During aortic cross-clamping both groups have shown significant increase in right atrium pressure, pulmonary capillary wedge pressure, stroke volume index and left ventricular systolic work index, and significant decrease in pulmonary vascular resistance index. There has been significant increase in mean blood pressure, pulmonary artery pressure, cardiac index and right ventricular systolic work index in the G Control. The clonidine group has shown significant heart rate decrease...

JUSTIFICATIVA Y OBJETIVOS: El pinzamiento aórtico infra-renal puede determinar alteraciones cardiovasculares. La clonidina, un a2-agonista, determina bradicardia y diminución de la presión arterial. El objetivo del estudio fue evaluar los efectos de la clonidina sobre la función cardiovascular, en canes sometidos a pinzamiento aórtico infra-renal. MÉTODO: El estudio aleatorio fue realizado en 16 canes, distribuidos en dos grupos: G Control - sin la utilización de clonidina y G Clon - clonidina, en la dosis inicial de 5 µg.kg-1, por vía venosa, inmediatamente antes del pinzamiento aórtico infra-renal, seguido de 2 µg.min-1.m2 hasta el final del estudio. En todos los animales fue realizada ligadura infra-renal de la aorta, por 45 minutos. Los atributos hemodinámicos fueron estudiados en los momentos C (control), después 10 (Ao10) y 25 (Ao25) minutos del pinzamiento aórtico, y después 10 (DAo10) y 25 (DAo25) minutos del despinzamiento aórtico. RESULTADOS: Durante el pinzamiento aórtico, hubo diferencia significante entre los grupos, en relación a la frecuencia cardíaca, presión arterial media e índice cardíaco (G Control > G Clon). Después del despinzamiento aórtico hubo diferencia significante entre los grupos, en relación a la frecuencia cardíaca (G Control > G Clon) y presiones del atrio derecho y de la arteria pulmonar ocluida (G Clon > G Control). Durante el pinzamiento aórtico, hubo en los dos grupos, aumento significante de las presiones del atrio derecho y arteria pulmonar ocluida, de los índices sistólico y del trabajo sistólico del ventrículo izquierdo, y diminución del índice de resistencia vascular pulmonar. En el grupo control hubo aumento significante de las presiones arterial media y de la arteria pulmonar, y de los índices cardíaco y del trabajo sistólico del ventrículo derecho. En el grupo clonidina, hubo diminución significante de la frecuencia cardíaca...

Anti-spasticity medications

Spasticity is common in patients with a variety of central nervous system disorders. It can lead to significant disability or cause complications that may result in severe morbidity. In such patients, treatment of spasticity is warranted. Several oral and parenteral medications are available for use in the treatment of spasticity. This article reviews the pharmacological properties and therapeutic effectiveness of these medications to provide a practical objective guide for physicians who may be involved in the management of spasticity