Clonidine as Pre-Anesthetic Medication in Cataract Extration: Comparison between 100 μg and 200 μg

A study of promethazine hydrochloride and pentazocine intramuscular sedation along with 2 % lidocaine hydrochloride and adrenaline and comparison to placebo along with 2 % lidocaine hydrochloride and adrenaline for surgical extraction of mandibular third molar

BACKGROUND AND OBJECTIVES

The main objective is to study and compare the sedative and analgesic effects of intramuscular injection fortwin-phenergan along with local anesthetic and normal saline placebo along with local anesthetics in mandibular third molar surgery. We also assessed and compared the postoperative experience of the patient in relation to the pain intensity, time to first analgesic taken and total number of analgesics consumed over a period of 48 h in the two groups.

MATERIALS AND METHODS

Patients who came to the Department of Oral and Maxillofacial Surgery, The Regional Dental College; with complaints regarding mandibular third molar were chosen for the treatment. Patients were evaluated using Corah Dental Anxiety Scale (CDAS) and those patients having a score of CDAS 13 and above were selected. Sixty patients were selected out of which 30 patients formed group 1 and another 30 patients group 2. The patients were randomly divided with flip method into group 1 (study group) and or group 2 (controlled group).

RESULTS

Our study results showed that the operating conditions for both the groups at the end of surgery were similar without significant difference. Most of the surgical procedures were graded as excellent and good in both the groups except that difficulty was encountered in two patients from group 1 and one from group 2.

CONCLUSION

It could be concluded that particular drugs do not have much influence on the surgical procedure in our study, but it was found that patients from group 1 were more cooperative as compared to group 2 when difficulty was encountered during the surgical procedure.

Alpha-2-agonists in day case anaesthesia

PURPOSE OF REVIEW

Alpha-2-agonists have long been known to have anaesthetic-sparing, sedative and analgesic properties which are desirable in day case anaesthesia. Their routine use was hampered by a high incidence of undesirable effects, however. In recent years, there have been many attempts to define a role for these unique agents in which their benefits would outweigh their apparent disadvantages.

RECENT FINDINGS

Many recent studies have confirmed the usefulness of alpha-2-agonists in providing sedation and analgesia, although the results have been far from consistent. Some, but by no means all studies have shown advantages over alternative agents, but concerns also remain over acute and possible long-term adverse effects.

SUMMARY

Alpha-2-agonists still have no clearly defined routine role in day surgery. Their most promising application is in limiting recovery agitation in children, but even here, there remain concerns about their routine use.

Effect of oral clonidine on acute intraocular pressure rise after phacoemulsification: a prospective double-blind, randomized, clinical trial

OBJECTIVE

To determine the efficacy and safety of oral clonidine in decreasing the prevalence and intensity of postoperative intraocular pressure (IOP) rise in those undergoing phacoemulsification.

METHODS

This was a prospective randomized, double-blind, placebo-controlled, clinical trial including 62 patients (each with 1 affected aye) with senile cataract scheduled for phacoemulsification who were randomly assigned to receive preoperative oral clonidine (5 μg/kg, 31 patients) or placebo (1 tablet, 31 patients). The IOP was measured preoperatively and at 6, 12, and 24 h postoperatively. The prevalence and intensity of the acute postoperative IOP rise was compared between and within the groups.

RESULTS

There was no significant difference between the 2 study groups regarding the baseline characteristics and the baseline IOP (P=0.628). Patients who received placebo as premedication had significantly higher IOP at 6 (17.96±5.49 vs. 13.61±4.09; P<0.001) and 12 (16.90±4.11 vs. 13.96±3.25; P=0.003) h postoperatively compared with those who received oral clonidine. However, there was no significant difference between the 2 groups regarding the IOP at 24 h after operation (15.41±3.96 vs. 16.01±3.41; P=0.0539). The prevalence of acute IOP rise (>21 mmHg) was significantly higher in placebo group compared with clonidine group (25.8% vs. 9.6%; P=0.091).

CONCLUSION

Administering preoperative oral clonidine in a dosage of 5 μg/kg, 2 h before phacoemulsification, significantly decreases the prevalence and intensity of acute postoperative IOP rise in those undergoing general anesthesia. Oral clonidine is safe, cheap, and easily accessible and, thus, it is recommended for controlling the IOP after phacoemulsification, especially in high-risk patients.