Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000400005
Brazilian Journal of Anesthesiology
Scientific Article

Clonidina por via venosa na técnica de hipotensão arterial induzida para timpanoplastias

Intravenous clonidine in the induced arterial hypotension technique for tympanoplasty

Renato Mestriner Stocche; Luiz Vicente Garcia; Marlene Paulino dos Reis; Oswaldo Miranda Junior

http://dx.doi.org/10.1590/S0034-70942003000400005 Braz J Anesthesiol, vol.53, n4, p.457-466, 2003
PDF
Downloads: 0
Views: 918

Resumo

JUSTIFICATIVA E OBJETIVOS: A hipotensão arterial induzida é uma técnica eficaz para diminuir o sangramento durante atos cirúrgicos. A clonidina é um a2-agonista de ação central que já se mostrou segura em anestesia. O objetivo deste estudo foi verificar a eficiência da clonidina por via venosa como droga principal na hipotensão arterial controlada. MÉTODO: Participaram do estudo prospectivo e duplamente encoberto, 36 pacientes de ambos os sexos, estado físico ASA I e II, divididos aleatoriamente em três grupos de 12 pacientes que receberam medicação pré-anestésica: clonidina 3 µg.kg-1 (C3), clonidina 5 µg.kg-1 (C5) ou solução fisiológica a 0,9% (Controle) 15 minutos antes da indução anestésica. A manutenção anestésica foi feita com isoflurano até a concentração máxima de 2%. Foram anotados a PA e a FC antes, com 1 e 5 minutos após a indução e a cada 5 minutos de anestesia. Pacientes há mais de 15 minutos recebendo isoflurano a 2% e que não apresentaram PAS menor que 80 mmHg receberam nitroprussiato de sódio para indução da hipotensão arterial. RESULTADOS: Três pacientes (25%) no grupo C3 , um (8%) no grupo C5 e oito (66%) no grupo controle necessitaram de nitroprussiato de sódio. A dose total de nitroprussiato para se induzir hipotensão arterial no grupo controle foi maior do que nos grupos C3 e C5 (p < 0,01). A incidência de complicações foi semelhante nos três grupos. CONCLUSÕES: A clonidina por via venosa pode levar à hipotensão arterial induzida em cirurgias de timpanoplastias utilizando-se técnica de anestesia balanceada com concentração de isoflurano limitada em 2%. Nas condições deste estudo, a clonidina não influenciou a qualidade anestésica e o tempo de despertar.

Palavras-chave

ANALGÉSICOS, CIRURGIA, CIRURGIA, HIPOTENSÃO CONTROLADA

Abstract

BACKGROUND AND OBJECTIVES: Induced arterial hypotension is an effective technique to decrease surgical bleeding. Clonidine is an a2-agonist with central action which was proven to be safe in anesthesia. This study aimed at evaluating the efficacy of intravenous clonidine as the primary drug for induced arterial hypotension. METHODS: Participated in this prospective double-blind study 36 patients of both genders, physical status ASA I and II, who were randomly distributed in three groups of 12 patients receiving the following preanesthetic medication 15 minutes before anesthetic induction: 3 µg.kg-1 clonidine (C3), 5 µg.kg-1 clonidine (C5) or 0.9% saline solution (Control). Anesthesia was maintained with isoflurane in a maximum concentration of 2%. BP and HR were recorded before, 1 and 5 minutes after induction and at every 5 minutes of anesthesia. Patients receiving 2% isoflurane for more than 15 minutes and not presenting SBP below 80 mmHg were administered sodium nitroprusside to induce arterial hypotension. RESULTS: Sodium nitroprusside was needed in three C3 group patients (25%), one C5 group patient (8%) and eight control group patients (66%). Total nitroprusside dose to induce arterial hypotension in the control group was higher as compared to groups C3 and C5 (p < 0.01). The incidence of complications was similar among groups. CONCLUSIONS: Intravenous clonidine may lead to induced hypotension during tympanoplasties under balanced anesthesia with isoflurane concentration limited to 2%. In the conditions of this study, clonidine has not affected anesthetic quality and emergence time.

Keywords

ANALGESICS, CONTROLLED HYPOTENSION, SURGERY, SURGERY

Referencias

Scholtes JL. Deliberate hypotension for middle ear microsurgery. Acta Anaesthesiol Belg. 1981;32:195-211.

Boisson-Bertrand D. Rédution du saignement en microchirurgie otorhinologique. Ann Fr Anesth Réanim. 1989;8:3A-4A.

Newman B, Gelb AW, Lam AM. The effect of isoflurane-induced hypotension on cerebral blood flow and cerebral metabolic rate for oxygen in humans. Anesthesiology. 1986;64:307-310.

Woodcock TE, Millard RK, Dixon J. Clonidine premedication for isoflurane-induced hypotension: Sympathoadrenal responses and a computer-controlled assessment of the vapour requirement. Br J Anaesth. 1988;60:388-394.

Vieira JL, Katayama M. Hipotensão induzida com bloqueadores alfa e beta 1. Halogenados: comparação entre enflurano, halotano e isoflurano em rinoplastias. Rev Bras Anestesiol. 1992;42:201-206.

Grando TA, Puricelli E, Ishiguro RM. Avaliação do risco de complicações em duas técnicas de hipotensão controlada em cirurgia ortognática. Rev Bras Anestesiol. 1996;46:1-7.

Laurito CE, Baughman VL, Becker GL. The effectiveness of oral clonidine as a sedative/anxiolytic and as a drug to blunt the hemodynamic responses to laringoscopy. J Clin Anesth. 1991;3:186-193.

Flacke JW, Bloor BC, Flacke WE. Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology. 1987;67:11-19.

Howie MB, Hiestand DC, Jopling MW. Effect of oral clonidine premedication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients. J Clin Anesth. 1996;8:263-272.

Ramesh VJ, Bhardwaj N, Batra YK. Comparative study of oral clonidine and diazepan as premedicants in children. Int j Clin Pharmacol Ther. 1997;35:218-221.

De Kock M, Versailles H, Colinet B et al. Epidemiology of the adverse hemodynamic events occurring during “clonidine anesthesia”: a prospective open trial of intraoperative intravenous clonidine. J Clin Anesth. 1995;7:403-410.

Welfringer P, Manel J, Garric J. Clonidine premedication and isoflurane anesthesia to reduce bleeding in otologic surgery. Ann Fr Anesth Reanim. 1992;11:125-311.

Toivonen J, Kaukinen S. Clonidine premedication: a useful adjunct in producing deliberate hypotension. Acta Anaesthesiol Scand. 1990;34:653-657.

Maroof M, Khan RM, Bhatti TH. Clonidine premedication for induced hypotension with total intravenous anaesthesia for middle ear microsurgery. Can J Anaesth. 1994;41:164-165.

Taittonen M, Kirvelä O, Aantaa R. The effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth. 1997;78:400-406.

Stühmeier KD, Mainzer B, Cierpka J. Small, oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology. 1996;85:706-712.

Goyagi T, Tanaka M, Nishikawa T. Oral clonidine premedication reduces the awakening concentration of isoflurane. Anesth Analg. 1998;86:410-413.

Benhamou D, Veillette Y, Narchi P. Ventilatory effects of premedication with clonidine. Anesth Analg. 1991;73:799-803.

Bernard J, Lagarde D, Souron R. Balanced postoperative analgesia: effect of intravenous clonidine on blood gases and pharmacokinetics of intravenous fentanyl. Anesth Analg. 1994;79:1126-1132.

Tanaka S, Tsuchida H, Namba H. Clonidine and lidocaine inhibition of isoflurane-induced tachycardia in humans. Anesthesiology. 1994;81:1341-1349.

Mikawa K, Nishina K, Maekawa N. Oral clonidine premedication reduces postoperative pain in children. Anesth Analg. 1996;82:225-230.

Eisenach J, Hood DD, Curry R. Intrathecal, but not intravenous, clonidine reduces experimental thermal or capsaicin-induced pain and hyperalgesia in normal volunteers. Anesth Analg. 1998;87:591.

5ddd31b50e88252e761da3e9 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections