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Rajabi M, Razavizade MR, Hamidi-Shad M, Tabasi Z, Akbari H, Hajian A. Magnesium Sulfate and Clonidine; Effects on Hemodynamic Factors and Depth of General Anesthesia in Cesarean Section. Anesth Pain Med 2020; 10:e100563. [PMID: 34150557 PMCID: PMC8207846 DOI: 10.5812/aapm.100563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
Background Making stable hemodynamic and also durable unawareness is a daily challenge in the setting of general anesthesia in women who undergo surgical delivery of neonate and have limitations to receive opioids derivatives. Objectives We aimed to evaluate the effects of magnesium sulfate and clonidine on hemodynamic changes and depth of anesthesia and in mentioned mothers and also in neonatal APGAR index. Methods Current randomized, double-blind controlled trial study was conducted among a total of 360 pregnant females (38 - 41 weeks of gestation) who underwent elective cesarean section. Participants were randomly divided into three drug-receiving groups (equal 120 members): magnesium sulfate (30 mg/kg), clonidine (3 µg/kg), and placebo (0.9% NaCl). Patients’ blood pressure, heart rate, cerebral state index (CSI) in specific time zones, and also late 24-hour recall were recorded. The CSI is an electroencephalographic monitoring method helping to assess the depth of anesthesia. Neonatal parameters, including APGAR score and umbilical venous blood sampling, were measured. Results Mean patients’ age was 28 ± 4.5. A significant decreasing and stabilizing effect of magnesium sulfate and clonidine on hemodynamic parameters (blood pressure and heart rate) was revealed (P < 0.001). Evidence implied on deeper anesthesia (lower CSI) among drug receivers comparing to placebo (P < 0.001). None of the participants experienced a late 24-hour recall postoperatively. All neonates were healthy, and no decrease was reported in APGAR score at minutes 1 and 5. Umbilical blood gas analysis showed no signs of acidosis and/or hypoxemia. Conclusions Adjuvant administration of either magnesium sulfate or clonidine is associated with hemodynamic stability and favorable unawareness in the setting of elective surgical delivery.
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Affiliation(s)
- Mehdi Rajabi
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad-Reza Razavizade
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Corresponding Author: Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
| | - Maryam Hamidi-Shad
- Department of Anesthesiology, Kashan University of Medical Sciences, Kashan, Iran
| | - Zohreh Tabasi
- Department of Gynecology, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Department of Biostatistics and Epidemiology, Kashan University of Medical Sciences, Kashan, Iran
| | - Abbas Hajian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Kim MH, Kim MS, Lee JH, Kim ST, Lee JR. Intravenously Administered Lidocaine and Magnesium During Thyroid Surgery in Female Patients for Better Quality of Recovery After Anesthesia. Anesth Analg 2018; 127:635-641. [DOI: 10.1213/ane.0000000000002797] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gagnon DJ, Fontaine GV, Riker RR, Fraser GL. Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations. Pharmacotherapy 2018; 37:1309-1321. [PMID: 28833346 DOI: 10.1002/phar.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Provision of adequate sedation is a fundamental part of caring for critically ill patients. Propofol, dexmedetomidine, and benzodiazepines are the most commonly administered sedative medications for adult patients in the intensive care unit (ICU). These agents are limited by adverse effects, need for a monitored environment for safe administration, and lack of universal effectiveness. Increased interest has recently been expressed about repurposing older pharmacologic agents for patient comfort in the ICU. Valproate, enteral clonidine, and phenobarbital are three agents with increasing evidence supporting their use. Potential benefits associated with their utilization are cost minimization and safe administration after transition out of the ICU. This literature review describes the historical context, pharmacologic characteristics, supportive data, and practical considerations associated with the administration of these agents for comfort in critically ill adult patients.
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Affiliation(s)
- David J Gagnon
- Department of Pharmacy, Maine Medical Center, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts
| | - Gabriel V Fontaine
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah.,Neurosciences Institute, Intermountain Healthcare, Salt Lake City, Utah.,Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah.,Roseman University College of Pharmacy, South Jordan, Utah
| | - Richard R Riker
- Department of Critical Care Medicine, Neuroscience Institute, Maine Medical Center, Portland, Maine
| | - Gilles L Fraser
- Department of Pharmacy, Maine Medical Center, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts.,Department of Critical Care Medicine, Neuroscience Institute, Maine Medical Center, Portland, Maine
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Duncan D, Sankar A, Beattie WS, Wijeysundera DN. Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery. Cochrane Database Syst Rev 2018; 3:CD004126. [PMID: 29509957 PMCID: PMC6494272 DOI: 10.1002/14651858.cd004126.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The surgical stress response plays an important role on the pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic agonists attenuate this response and may help prevent postoperative cardiac complications. OBJECTIVES To determine the efficacy and safety of α-2 adrenergic agonists for reducing mortality and cardiac complications in adults undergoing cardiac surgery and non-cardiac surgery. SEARCH METHODS We searched CENTRAL (2017, Issue 4), MEDLINE (1950 to April Week 4, 2017), Embase (1980 to May 2017), the Science Citation Index, clinical trial registries, and reference lists of included articles. SELECTION CRITERIA We included randomized controlled trials that compared α-2 adrenergic agonists (i.e. clonidine, dexmedetomidine or mivazerol) against placebo or non-α-2 adrenergic agonists. Included trials had to evaluate the efficacy and safety of α-2 adrenergic agonists for preventing perioperative mortality or cardiac complications (or both), or measure one or more relevant outcomes (i.e. death, myocardial infarction, heart failure, acute stroke, supraventricular tachyarrhythmia and myocardial ischaemia). DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality, extracted data and independently performed computer entry of abstracted data. We contacted study authors for additional information. Adverse event data were gathered from the trials. We evaluated included studies using the Cochrane 'Risk of bias' tool, and the quality of the evidence underlying pooled treatment effects using GRADE methodology. Given the clinical heterogeneity between cardiac and non-cardiac surgery, we analysed these subgroups separately. We expressed treatment effects as pooled risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS We included 47 trials with 17,039 participants. Of these studies, 24 trials only included participants undergoing cardiac surgery, 23 only included participants undergoing non-cardiac surgery and eight only included participants undergoing vascular surgery. The α-2 adrenergic agonist studied was clonidine in 21 trials, dexmedetomidine in 24 trials and mivazerol in two trials.In non-cardiac surgery, there was high quality evidence that α-2 adrenergic agonists led to a similar risk of all-cause mortality compared with control groups (1.3% with α-2 adrenergic agonists versus 1.7% with control; RR 0.80, 95% CI 0.61 to 1.04; participants = 14,081; studies = 16). Additionally, the risk of cardiac mortality was similar between treatment groups (0.8% with α-2 adrenergic agonists versus 1.0% with control; RR 0.86, 95% CI 0.60 to 1.23; participants = 12,525; studies = 5, high quality evidence). The risk of myocardial infarction was probably similar between treatment groups (RR 0.94, 95% CI 0.69 to 1.27; participants = 13,907; studies = 12, moderate quality evidence). There was no associated effect on the risk of stroke (RR 0.93, 95% CI 0.55 to 1.56; participants = 11,542; studies = 7; high quality evidence). Conversely, α-2 adrenergic agonists probably increase the risks of clinically significant bradycardia (RR 1.59, 95% CI 1.18 to 2.13; participants = 14,035; studies = 16) and hypotension (RR 1.24, 95% CI 1.03 to 1.48; participants = 13,738; studies = 15), based on moderate quality evidence.There was insufficient evidence to determine the effect of α-2 adrenergic agonists on all-cause mortality in cardiac surgery (RR 0.52, 95% CI 0.26 to 1.04; participants = 1947; studies = 16) and myocardial infarction (RR 1.01, 95% CI 0.43 to 2.40; participants = 782; studies = 8), based on moderate quality evidence. There was one cardiac death in the clonidine arm of a study of 22 participants. Based on very limited data, α-2 adrenergic agonists may have reduced the risk of stroke (RR 0.37, 95% CI 0.15 to 0.93; participants = 1175; studies = 7; outcome events = 18; low quality evidence). Conversely, α-2 adrenergic agonists increased the risk of bradycardia from 6.4% to 12.0% (RR 1.88, 95% CI 1.35 to 2.62; participants = 1477; studies = 10; moderate quality evidence), but their effect on hypotension was uncertain (RR 1.19, 95% CI 0.87 to 1.64; participants = 1413; studies = 9; low quality evidence).These results were qualitatively unchanged in subgroup analyses and sensitivity analyses. AUTHORS' CONCLUSIONS Our review concludes that prophylactic α-2 adrenergic agonists generally do not prevent perioperative death or major cardiac complications. For non-cardiac surgery, there is moderate-to-high quality evidence that these agents do not prevent death, myocardial infarction or stroke. Conversely, there is moderate quality evidence that these agents have important adverse effects, namely increased risks of hypotension and bradycardia. For cardiac surgery, there is moderate quality evidence that α-2 adrenergic agonists have no effect on the risk of mortality or myocardial infarction, and that they increase the risk of bradycardia. The quality of evidence was inadequate to draw conclusions regarding the effects of alpha-2 agonists on stroke or hypotension during cardiac surgery.
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Affiliation(s)
- Dallas Duncan
- University of TorontoDepartment of Anesthesia123 Edward Street12th FloorTorontoONCanadaM5G 1E2
| | - Ashwin Sankar
- University of TorontoDepartment of Anesthesia123 Edward Street12th FloorTorontoONCanadaM5G 1E2
| | - W Scott Beattie
- Toronto General Hospital, University Health NetworkDepartment of AnaesthesiaEN 3‐453 Toronto General Hospital, University Health Network200 Elizabeth StreetTorontoONCanadaM5G 2C4
| | - Duminda N Wijeysundera
- St. Michael's HospitalLi Ka Shing Knowledge Institute30 Bond StreetTorontoOntarioCanadaM5B 1W8
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Kim MH, Kim MS, Lee JH, Seo JH, Lee JR. Can quality of recovery be enhanced by premedication with midazolam?: A prospective, randomized, double-blind study in females undergoing breast surgery. Medicine (Baltimore) 2017; 96:e6107. [PMID: 28207530 PMCID: PMC5319519 DOI: 10.1097/md.0000000000006107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Preoperative anxiety is known to be related with the postoperative outcomes, although it remains unclear whether pharmacologic anxiolysis preoperatively leads to better postanesthesia recovery. Hence, the purpose of this study was to assess whether midazolam premedication would result in improved Quality of Recovery-40 survey scores, as a postoperative recovery parameter, in female patients undergoing mastectomy. METHODS This randomized double-blind study was performed at Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea. Eighty-two females undergoing breast cancer surgery with propofol-remifentanil anesthesia were enrolled and randomized to receive midazolam 0.02 mg kg (group M) or saline (group C). Anesthesia was conducted with total intravenous anesthesia using propofol and remifentanil. On postoperative day 1, the Quality of Recovery-40 survey scores were surveyed. RESULTS The global Quality of Recovery-40 survey scores on postoperative day 1 did not significantly differ between groups M and C (183 vs 181, P = 0.568). However, the induction time was significantly shorter in group M (3.2 vs 4.5 min, P < 0.001), as was the total intraoperative propofol consumption (705 vs 1004 mg; P = 0.022). CONCLUSION Midazolam premedication does not seem to improve the postoperative quality of recovery, though group M showed faster induction and less propofol consumption.
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Affiliation(s)
- Myoung Hwa Kim
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Min Soo Kim
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Jae Hi Seo
- Department of Anesthesiology and Pain Medicine
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
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Ulusoy H, Coskun I, Arslan M. Effects of midazolam or tramadol premedication on early cognitive function in endoscopic retrograde cholangiopancreatography (ERCP): A randomized, controlled, double-blind study. J Int Med Res 2016; 44:542-56. [PMID: 26944385 PMCID: PMC5536697 DOI: 10.1177/0300060515600189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/22/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the sedative efficacy and effects on early period cognitive function of premedication in endoscopic retrograde cholangiopancreatography (ERCP). METHODS Forty patients (18-70 years; American Society of Anesthesiology risk category I-III) undergoing elective ERCP were randomized to receive oral premedication with 0.15 mg/kg midazolam or 1 mg/kg tramadol. Cognitive function was determined by mini-mental test (MMT). Target scores for effective sedation were determined as a Bispectral index score of 70-90 and modified Ramsay Sedation Scale score (mRSS) of 2-4. RESULTS Global MMT score was not significantly different between treatment groups at 60 min post-ERCP. A significant deterioration in the MMT subcategory of recall was determined in with midazolam versus tramadol. Level of sedation (mRSS) was higher in with midazolam compared with tramadol reaching statistical significance at 30 min after drug administration. CONCLUSIONS Although more effective sedation was obtained with midazolam in patients undergoing ERCP, there was a dysfunction in memory recall. It was concluded, however, that early cognitive functions were generally preserved with both drugs.
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Affiliation(s)
- Hulya Ulusoy
- Department of Anesthesiology and Critical Care, Karadeniz Technical University, Faculty of Medicine, TRABZON, Turkey
| | | | - Mehmet Arslan
- Department of Gastroenterology, Karadeniz Technical University, Faculty of Medicine, TRABZON, Turkey
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Agrawal M, Asthana V, Sharma JP. Efficacy of intravenous midazolam versus clonidine as premedicants on bispectral index guided propofol induction of anesthesia in laparoscopic cholecystectomy: A randomized control trial. Anesth Essays Res 2015; 8:302-6. [PMID: 25886325 PMCID: PMC4258972 DOI: 10.4103/0259-1162.143117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Midazolam and clonidine are preferred premedicants whose effects are not restricted to the preoperative period. In addition, these premedicants significantly modulate not only the intraoperative requirements of the anesthetic agents, but also the postoperative outcome. We aim to compare the efficacy of both the agents in view of premedication, induction characteristics, hemodynamic changes and postoperative complications utilizing bispectral index (BIS) using propofol anesthesia. MATERIALS AND METHODS The type of this study was randomized control trial conducted on patients undergoing laparoscopic cholecystectomy under general anesthesia with endotracheal intubation. Study included 105 patients of either sex aged 20-60 years. The patients were randomly allocated into three groups: Intravenous midazolam (Group 1), clonidine (Group 2), and normal saline (Group 3) (control). The initial value of BIS and Ramsay Sedation Score, dose of propofol required for induction were noted in each group and monitored for pulse rate, electrocardiograph, noninvasive blood pressure, and BIS. RESULTS The requirement of propofol ranged from 40 to 150 mg. Mean requirement was maximum in Group 3 (109.43 ± 20.14 mg) and it was minimum in Group 1 (78.57 ± 22.15 mg). A significant reduction in consumption of propofol with the use of midazolam (P < 0.001) and clonidine (P < 0.001) was observed. Both premedicants partially attenuates laryngoscoy and intubation response along with reduction in the incidence of postoperative complications. CONCLUSION Both clonidine and midazolam contributed equally in lowering propofol consumption. Reduction in the induction dosage of propofol and hemodynamic variations were also observed to be similar with the use of midazolam or clonidine as premedicants. Both provide a beneficial effect in relation to recovery and less postoperative complications. However clonidine premedication was found to be more effective in preventing post operative shivering and can be recommended in routine practice.
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Affiliation(s)
- Manish Agrawal
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Veena Asthana
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Jagdish P Sharma
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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Comparison of clonidine and midazolam premedication before endoscopic sinus surgery: results of clinical trial. Clin Exp Otorhinolaryngol 2014; 7:307-11. [PMID: 25436051 PMCID: PMC4240489 DOI: 10.3342/ceo.2014.7.4.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/12/2013] [Accepted: 11/19/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Premedication with clonidine has been found to reduce the bleeding during endoscopic sinus surgery (ESS), therefore lowering the risk of surgical complications. Premedication is an essential part of pre-surgical care and can potentially affect magnitude of systemic stress response to a surgical procedure. The aim of this study was to compare the efficacy of premedication with clonidine and midazolam in patients undergoing sinus surgery. METHODS Forty-four patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or midazolam as a premedication before receiving propofol/remifentanil total intravenous anesthesia. The effect of this premedication choice on anesthetic requirements, intraoperative hemodynamic profile, preoperative anxiety and sedation as well as postoperative pain and shivering were examined in each premedication group. RESULTS Total intraoperative remifentanil requirement was lower in the clonidine group as compared to the midazolam group 503.2±147.0 µg vs. 784.5±283.8 µg, respectively (P<0.001). There was no difference between groups in required induction dose of propofol, level of preoperative anxiety, level of sedation and postoperative shivering. Intraoperative systemic blood pressure and heart rate response had a more favorable profile in patients premedicated with clonidine. Postoperative pain assessed by visual analogue scale for pain was lower in the clonidine group compared with to the midazolam premedication group. CONCLUSION Premedication with clonidine provides better attenuation of hemodynamic response and reduction of intraoperative remifentanil requirements in patients undergoing ESS. Postoperative pain seems to be better controlled after clonidine premedication as well.
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Bienert A, Wawrzyniak K, Wiczling P, Przybyłowski K, Kokot ZJ, Matysiak J, Pachutko A, Józefowicz M, Kusza K, Grześkowiak E. Melatonin and clonidine premedication has similar impact on the pharmacokinetics and pharmacodynamics of propofol target controlled-infusions. J Clin Pharmacol 2014; 55:307-16. [DOI: 10.1002/jcph.401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Agnieszka Bienert
- Department of Clinical Pharmacy and Biopharmacy; Poznan University of Medical Sciences; ul. Marii Magdaleny 14 61 - 861 Poznan Poland
| | - Katarzyna Wawrzyniak
- Department of Anesthesiology and Intensive Therapy; Collegium Medicum in Bydgoszcz; Nicolaus Copernicus University in Torun; ul. Marii Skłodowskiej - Curie 9 85-094 Bydgoszcz Poland
| | - Paweł Wiczling
- Department of Biopharmaceutics and Pharmacodynamics; Medical University of Gdansk; ul. Hallera 107 80-401 Gdansk Poland
| | - Krzysztof Przybyłowski
- Department of Clinical Pharmacy and Biopharmacy; Poznan University of Medical Sciences; ul. Marii Magdaleny 14 61 - 861 Poznan Poland
| | - Zenon J. Kokot
- Department of Inorganic and Analytical Chemistry; Poznan University of Medical Sciences; ul. Grunwaldzka 6 60 - 780 Poznan Poland
| | - Jan Matysiak
- Department of Inorganic and Analytical Chemistry; Poznan University of Medical Sciences; ul. Grunwaldzka 6 60 - 780 Poznan Poland
| | - Agnieszka Pachutko
- Department of Clinical Pharmacy and Biopharmacy; Poznan University of Medical Sciences; ul. Marii Magdaleny 14 61 - 861 Poznan Poland
| | - Martyna Józefowicz
- Department of Biopharmaceutics and Pharmacodynamics; Medical University of Gdansk; ul. Hallera 107 80-401 Gdansk Poland
| | - Krzysztof Kusza
- Department of Anesthesiology and Intensive Therapy; Collegium Medicum in Bydgoszcz; Nicolaus Copernicus University in Torun; ul. Marii Skłodowskiej - Curie 9 85-094 Bydgoszcz Poland
- Department of Anesthesiology and Intensive Therapy; Poznan University of Medical Sciences; ul. Marii Magdaleny 14 61 - 861 Poznan Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy; Poznan University of Medical Sciences; ul. Marii Magdaleny 14 61 - 861 Poznan Poland
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Wawrzyniak K, Burduk PK, Cywinski JB, Kusza K, Kazmierczak W. Improved quality of surgical field during endoscopic sinus surgery after clonidine premedication--a pilot study. Int Forum Allergy Rhinol 2014; 4:542-7. [PMID: 24591266 DOI: 10.1002/alr.21308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/09/2014] [Accepted: 01/17/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Inadequate surgical field visualization due to intraoperative bleeding during endoscopic sinus surgery (ESS) can cause major complications. The aim of this prospective study was to compare the effect of preoperative administration of clonidine and melatonin on the quality of the surgical field visualization and selected aspects of presurgical premedication. METHODS Twenty-six patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or melatonin as preoperative premedication. During the operation, the quality of the surgical field was assessed and graded using the scale proposed by Boezaart. The evaluations were done at 15, 30, and 60 minutes after incision. The effect of this premedication choice on the intraoperative and postoperative hemodynamic profile was examined in each group. Anxiolytic effects of both premedication agents were assessed using the visual analogue scale for anxiety (VAS-A). Propofol dose and induction time (the time for bispectral index [BIS] to reach 45), anesthesia and surgical procedures time, and recovery time (the time for BIS to reach 90) were assessed in both groups as well. RESULTS The quality of the surgical field was consistently better in 2 of 3 time points in the clonidine group. Perioperative mean arterial pressure and intraoperative heart rate had a more favorable profile in patients premedicated with clonidine. There were no differences in other measured parameters between groups. CONCLUSION Premedication with clonidine before ESS provides better quality of surgical field and more favorable hemodynamic profile as compared to melatonin.
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Affiliation(s)
- Katarzyna Wawrzyniak
- Department of Anesthesiology and Intensive Therapy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University of Torun, Bydgoszcz, Poland
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Sahoo S, Kaur M, Tripathy HK, Kumar A, Kohli S, Nanda S. Comparative evaluation of midazolam and clonidine as pediatric oral premedication. Anesth Essays Res 2013; 7:221-7. [PMID: 25885837 PMCID: PMC4173523 DOI: 10.4103/0259-1162.118967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Clonidine provides many desirable effects like sedation, analgesia, anxiolysis, and hemodynamic stability and these properties make it a potentially useful anesthetic premedication in the pediatric settings. The aim of this study was to compare oral midazolam (0.5 mg/kg), which is considered gold standard with oral clonidine (5 mcg/kg) as a premedication in pediatric patients. MATERIALS AND METHODS Sixty children classified as American Society of Anesthesiologists physical status I, aged between 2 and 12, who were scheduled to undergo an elective surgery, were enrolled for a prospective, randomized, and double blind controlled trial. They received either oral midazolam (Group M) or oral clonidine (Group C) 60 minutes before induction of anesthesia and were submitted to an evaluation of anxiety and sedation scores. We also evaluated secondary outcomes such as palatability, parental separation, effect on hemodynamic status, co-operation during venipuncture and facemask application, postoperative analgesic requirement, and recovery profile. RESULTS Oral midazolam had better efficacy in the preoperative period as sedative and anxiolytic (P < 0.001), allowed better cooperation during venipuncture and facemask application (P < 0.001), whereas, oral clonidine provided better palatability (P < 0.001), parental satisfaction (P < 0.001), stable perioperative hemodynamics (P < 0.001), better postoperative analgesia (P < 0.001), and night sleep pattern (P < 0.05) without any noticeable side effects (P > 0.05). CONCLUSION We conclude that under the conditions of this study, oral midazolam is a better medication than clonidine in children in preoperative period while clonidine is a better medication postoperatively with added advantage of palatability, hemodynamic stability, and no significant side effects.
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Affiliation(s)
- Sangeeta Sahoo
- Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Hemant Kumar Tripathy
- Department of Anesthesia and Critical Care, Maharaja Krishna Chandra Gajapati Medical College, Berhampur University, Odisha, India
| | - Ajeet Kumar
- Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Santavana Kohli
- Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Samridhi Nanda
- Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Bopp EJ, Spence DL, Burkard JF. A preoperative stress inquiry and a vulnerable US military population. J Perianesth Nurs 2013; 28:67-76. [PMID: 23522266 DOI: 10.1016/j.jopan.2012.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 11/07/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
The preoperative setting is fraught with many stressors, often increasing in magnitude as patients progress through the perioperative environment. Individuals exposed to traumatic or threatening environments, such as US military personnel involved in combat operations, may be at increased risk of developing altered mental and physical health conditions. Collectively, this may result in a hyperarousal state significantly amplifying psychological symptoms and magnifying physiological alterations. The purposes of this article are to (1) describe stress-related concepts and preoperative stress, (2) discuss potential risk factors for preoperative stress in the adult surgical population, (3) present various psychological and physiological measures of preoperative stress, (4) explore preoperative stress interventions, and (5) discuss potential implications for future preoperative stress research in high-stressed populations.
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Affiliation(s)
- Eric J Bopp
- University of San Diego, Hahn School of Nursing and Health Science, San Diego, CA 92110, USA.
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Jabbary Moghaddam M, Ommi D, Mirkheshti A, Dabbagh A, Memary E, Sadeghi A, Yaseri M. Effects of clonidine premedication upon postoperative shivering and recovery time in patients with and without opium addiction after elective leg fracture surgeries. Anesth Pain Med 2013; 2:107-10. [PMID: 24244918 PMCID: PMC3821124 DOI: 10.5812/aapm.7143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 08/06/2012] [Accepted: 08/29/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Opium is a highly addictive agent and the most common narcotic often misused in Iran. The pharmacokinetic of anesthetic drugs in patients with opium addiction is one of the great challenges for anesthesiologists. Hemodynamic instability and postoperative side effects are of these challenges which should be managed correctly. OBJECTIVES In this study we aimed to assess the effects of clonidine upon post anesthesia shivering and recovery time in patients with and without opium addiction after general anesthesia to decrease the subsequent complications related to the shivering and elongation of recovery time. PATIENTS AND METHODS In a randomized clinical trial, 160 patients candidates for elective leg fracture operations under general anesthesia were studied in four groups of 40 patients: Group 1 (placebo 1) were patients without addiction who got placebo 90 minutes before the operation. Group 2 (placebo 2) were patients with opium addiction which received placebo as group 1. Group 3 (Clonidine 1) patients without addiction who got clonidine 90 minutes before the operation and group 4 (Clonidine 2) who were opium addicted ones which received clonidine as premedication. RESULTS None of the patients with and without addiction in clonidine groups had shivering after the operation but in placebo groups shivering was observed and the difference between clonidine and placebo groups was statistically significant (P < 0.01). Recovery time in clonidine groups of patients with and without addiction was less than placebo ones (both P < 0.01) which the magnitude of difference was higher in opium addicted than non-addicted patients (P = 0.04). CONCLUSIONS Premedication with clonidine in patients with and without opium addiction can be effective to decrease the incidence of shivering and recovery time after operation.
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Affiliation(s)
| | - Davood Ommi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mirkheshti
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Alireza Mirkheshti, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel.: +98-2177567840, Fax: +98-2177567840, E-mail:
| | - Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Memary
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
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Acar HV, Cuvaş O, Ceyhan A, Dikmen B. Acupuncture on Yintang point decreases preoperative anxiety. J Altern Complement Med 2012; 19:420-4. [PMID: 23270318 DOI: 10.1089/acm.2012.0494] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the effect of ear-press needle acupuncture on Yintang point for preoperative anxiety. DESIGN This was a prospective, randomized, single-blind, controlled study. SETTINGS/LOCATION The study setting was the Department of Anesthesiology in Ankara Training and Research Hospital of Ministry of Health, Ankara, Turkey. SUBJECTS The study comprised 52 adult surgical patients. INTERVENTIONS A single, 20-minute session of single-point acupuncture was applied on Yintang (acupuncture group) or sham point (sham acupuncture group). OUTCOME MEASURES The efficacy of acupuncture was evaluated by means of the changes in bispectral index (BIS) and STAI (State-Trait Anxiety Index). RESULTS BIS values in the acupuncture group were significantly lower than in the sham group in all time intervals (p<0.0042). BIS values were lower than baseline in the study group during the entire study period (p<0.0004) while no such effect has been observed in the sham group (p>0.0004). Mean values of state anxiety (STAI-S) decreased after acupuncture in the study group (p=0,018), while no change was observed in trait anxiety (STAI-T) (p=0.156). Patients of the sham group showed no change in both parameters (p=0.387 and p=0,116). CONCLUSIONS Ear-press needle acupuncture on Yintang point reduces preoperative anxiety in adult surgical patients.
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Affiliation(s)
- H Volkan Acar
- Department of Anesthesiology and Intensive Care, Ankara Training and Research Hospital of Ministry of Health, Ankara, Turkey.
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Studer FR, Grätz KW, Mutzbauer TS. Comparison of clonidine and midazolam as anxiolytic premedication before wisdom tooth surgery: a randomized, double-blind, crossover pilot study. Oral Maxillofac Surg 2012; 16:341-347. [PMID: 22411483 DOI: 10.1007/s10006-012-0319-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 02/20/2012] [Indexed: 05/31/2023]
Abstract
PURPOSE Anxiolytic and possible side effects of clonidine 150 μg compared to midazolam 7.5 mg for premedication in surgical wisdom tooth extraction were evaluated. METHODS In a prospective, randomized, double-blind crossover trial, ten patients undergoing bilateral wisdom tooth surgery received clonidine or midazolam orally 1 h before the treatment. Patients receiving midazolam for the first surgery received clonidine at the second surgery and vice versa. The anxiolytic efficacy was evaluated with a visual analogue scale (VAS) upon admission and 30, 50 and 60 min after administration of the medication. Patient satisfaction was recorded on a VAS after surgery and 7 days postoperatively. RESULTS As soon as 30 min after administration of midazolam (p < 0.03) and clonidine (p < 0.02), an anxiolytic effect was recorded. Both medications did not differ in patient satisfaction. CONCLUSION Oral administration of clonidine 150 μg and midazolam 7.5 mg were rated as medications with equal anxiolytic effects before wisdom tooth surgery under local anesthesia.
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Affiliation(s)
- Franziska R Studer
- Department of Craniomaxillofacial and Oral Surgery, University Hospital Zurich, Frauenklinikstr. 24, 8091 Zurich, Switzerland
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Zalunardo MP, Ivleva-Sauerborn A, Seifert B, Spahn DR. [Quality of premedication and patient satisfaction after premedication with midazolam, clonidine or placebo : Randomized double-blind study with age-adjusted dosage]. Anaesthesist 2010; 59:410-8. [PMID: 20224951 DOI: 10.1007/s00101-010-1695-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Premedication aims at alleviating preoperative anxiety and nervousness and also at minimizing adverse effects. To our knowledge there is no study comparing efficacy and patient satisfaction of different premedications in age-adjusted dosage. METHODS In 139 patients anxiety, sedation and adverse effects were measured at 6 consecutive perioperative time points after administration of midazolam, clonidine or a placebo. RESULTS Midazolam showed the strongest sedative and anxiolytic effects, clonidine less and placebo none. Clonidine and midazolam reduced the risk of postoperative nausea and vomiting (PONV). Midazolam showed minimal adverse effects and the best patient satisfaction. CONCLUSION Midazolam was the most anxiolytic, sedative and favored premedication with the least adverse effects. Most patients would choose midazolam next time.
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Affiliation(s)
- M P Zalunardo
- Institut für Anästhesiologie, Universitätsspital Zürich, Rämistr. 100, 8091 Zürich, Schweiz.
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