Search

Background: While opiate withdrawal syndrome (OWS) typically resolves within a few weeks, the discomfort in the initial days after discontinuing opioid use is intense. In this study, we compared the effects of 2 drugs, clonidine and dexmedetomidine, for treating OWS in patients admitted to the Toxicology ICU at Loghman-e Hakim Hospital. Methods: We collected patient information for individuals diagnosed with OWS in this clinical trial study. Fifty-two patients, matched based on the type of drug use (methadone, opiate, heroin), were included and divided into 2 groups. We compared the clinical effects of 2 drugs, dexmedetomidine and clonidine, on OWS symptoms using the Clinical Opiate Withdrawal Scale (COWS). The dexmedetomidine group received a dosage of 0.5 mcg/kg/h continuous IV infusion; not to exceed 24 h, while the clonidine group received 1.2 mg per day for 24 h. We completed the COWS standard checklist and compared the results after 0, 12, and 24 h. Results: At Zero hours' patients who were administered dexmedetomidine had a significantly higher average COWS score of 0.684, compared to a score of 0.053 for patients who received clonidine (p-value=.000201). At the 12-h, the distinction between the 2 treatment groups was no longer statistically significant, as evidenced by a p-value of .162829 (dexmedetomidine: 0.105 vs. clonidine: 0.000). Conclusions: The results suggest that dexmedetomidine is superior to clonidine in reducing withdrawal symptoms. The study found that both medications had a significant decrease in COWS scores over time, indicating their effectiveness in alleviating withdrawal symptoms as time passed. Resumen: Antecedentes: si bien el síndrome de abstinencia de opiáceos (SOW) generalmente se resuelve en unas pocas semanas, el malestar en los primeros días después de suspender el uso de opioides es intenso. En este estudio, comparamos los efectos de dos fármacos, clonidina y dexmedetomidina, para el tratamiento del síndrome de abstinencia de opiáceos (SOW) en pacientes ingresados en la UCI de Toxicología del Hospital Loghman-e Hakim. Métodos: En este estudio clínico aleatorizado, se recopiló información de pacientes de personas diagnosticadas con síndrome de abstinencia de opiáceos. Se incluyeron y dividieron en dos grupos cincuenta y dos pacientes, emparejados según el tipo de consumo de drogas (metadona, opiáceos, heroína). Los efectos clínicos de dos fármacos, dexmedetomidina y clonidina, sobre los síntomas del síndrome de abstinencia de opiáceos se compararon mediante la Escala Clínica de Abstinencia de Opiáceos (COWS). El grupo de dexmedetomidina recibió una dosis de 0,5 mcg/kg/h en infusión intravenosa continua; no exceder las 24 horas, mientras que el grupo de clonidina recibió 1,2 mg/día repartidos durante 24 horas. La lista de verificación estándar COWS se completó y comparó a las 0, 12 y 24 horas. Resultados: En las horas cero, los pacientes a los que se les administró dexmedetomidina tuvieron una puntuación COWS promedio significativamente mayor, de 0,684, en comparación con una puntuación de 0,053 para los pacientes que recibieron clonidina (p = 0,000201). A las 12 horas, la distinción entre los dos grupos de tratamiento ya no era estadísticamente significativa, como lo demuestra un p de 0,162,829 (dexmedetomidina: 0,105 frente a clonidina: 0,000). Conclusiones: Los resultados sugieren que la dexmedetomidina es superior a la clonidina para reducir los síntomas de abstinencia. La investigación demostró una disminución significativa en las puntuaciones COWS de ambos medicamentos con el tiempo, lo que indica su eficacia para aliviar los síntomas de abstinencia conforme avanzaba el tiempo.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep. Objective: In this systematic review, we aimed to summarize the effect of clonidine on sleep quality and duration, nightmares, and PTSD symptom severity in adults with PTSD. Method: PubMed (Medline), Embase, PsycINFO, CINAHL, and clinicaltrials.gov were searched up to April 2023. Studies on clonidine use in adult PTSD patients reporting data on the effect on sleep, nightmares, and PTSD symptoms were included. A narrative summary and a meta-analysis of the study findings are presented. Results: Ten reports, accounting for N = 569 patients with PTSD (145 on clonidine and 436 controls), were included in the final selection. There were four case reports, four observational studies, one non-blind clinical trial, and one crossover randomized controlled trial (RCT). Median clonidine dose was 0.15 mg/day (range: 0.1–0.5 mg/day). Median followup time was 31 days (range: 3 days to 19 months). The quality of the evidence was rated from very low to low. There was marked between-study heterogeneity and low power in the individual studies, but many reported improved sleep quality, nightmare reduction, and improvement of PTSD symptoms for patients treated with clonidine. Meta-analysis was only possible for two studies reporting the effect of clonidine on nightmares, and showed no difference from the comparator (i.e. prazosin or terazosin) (odds ratio: 1.16; 95% confidence interval: 0.66 to 2.05), potentially pointing towards non-inferiority between these medications. Conclusions: Future research, such as well-powered RCTs, is needed to identify the efficacy in the lower dose range and the most suitable treatment group, and to obtain good evidence on the effects of clonidine in the treatment of sleep disorders related to PTSD. [ABSTRACT FROM AUTHOR]

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

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

La anestesia libre de opioides es una técnica reconocida en la cirugía no cardiaca, sin embargo hay pocos reportes de su empleo en cardiocirugía. Presentamos un paciente de 76 años con alergia demostrada a opioides, programado para revascularización miocárdica quirúrgica en el cual empleamos esta técnica por primera vez en nuestro centro. Su evolución fue favorable con dolor posoperatorio según EVA que osciló entre 0 y 3 y fue tratado con AINES según protocolo.

Objetivo: Esse estudo analisa o perfil dos pacientes hipertensos atendidos no ambulatório de cardiologia do Hospital Universitário Walter Cantídio. Métodos: Foi realizado uma revisão de prontuários eletrônicos, analisando o tratamento de 774 pacientes. Os pacientes foram classificados conforme o número de anti-hipertensivos de classes distintas: monoterapia (uso de um fármaco); terapia dupla (uso de dois); terapia tripla (uso de três); terapia quadrupla (uso de quatro) e politerapia (maior que quatro). Resultados: 145 pacientes estavam em monoterapia, sendo que o medicamento mais usado foi a losartana (35 indivíduos). Das 288 pessoas em terapia dupla, a losartana e a hidroclorotiazida foram mais prevalentes com 45 usuários. Na terapia tripla, dos 244 pacientes os mais utilizados foram losartana, anlodipino e hidroclorotiazida com 33 pacientes. Dos 91 pacientes em terapia quádrupla, a associação foi losartana, hidroclorotiazida, anlodipino e atenolol. Na politerapia, 6 pacientes, a associação mais frequente foi losartana, hidroclorotiazida, anlodipino, atenolol, espironolactona, clonidina e hidralazina com 2 pacientes. Conclusão: Assim, observamos que o tratamento dos pacientes é limitado. Esse fato é justificado devido à condição socioeconômica dos usuários desse serviço, pois muitos não dispõem de uma renda que permita a aquisição de medicamentos. Assim, os profissionais desse serviço adequam os seus conhecimentos para trabalhar com pequeno espectro terapêutico.

A cardiovascular disease is a group of diseases of the heart and blood vessels. The most common cause of death in humans is associated precisely with cardiovascular diseases, and α2-adrenergic receptors (α2-AR) are known to be involved. α2-AR reduce the central sympathetic output and peripheral release of catecholamines and therefore, can prevent sympathetic hyperactivity and hypertension. Therefore, various agonists and antagonists of adrenergic receptors are widely used in the treatment of cardiovascular diseases in medicine, among them clonidine and ST-91. The objective was to compare the effects of clonidine and ST-91, selective agonists of α2-AR, on the cardiac activity in rats. Stimulation of α2-AR by ST-91 (0.01 mg/kg) causes a short-term negative chronotropic effect, while stimulation of α2-adrenergic receptors with clonidine (0.01 mg/kg) led to a negative chronotropic effect throughout the experiment. We hypothesize that the short-term effect of ST-91 on heart rate is associated with the activation of one of the three subtypes of α2-adrenergic receptors. Identification of the specific subtype due to which this effect was observed is part of future research. [ABSTRACT FROM AUTHOR]

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

O alívio inadequado da dor após a reconstrução do ligamento cruzado anterior afeta a mobilidade, leva ao desenvolvimento de aderências, inserção do ligamento enfraquecido e atrofia muscular. O bloqueio do canal adutor para analgesia pós‐operatória preserva a força do quadríceps. O presente estudo foi feito para comparar o período sem dor em pacientes de reconstrução artroscópica do ligamento cruzado anterior, submetidos ao bloqueio do canal adutor guiado por ultrassom com ropivacaína isolada e ropivacaína + clonidina. Um estudo prospectivo, randômico e duplo‐cego foi conduzido com 63 pacientes adultos, estado físico ASA I–II, submetidos à reconstrução do ligamento cruzado anterior. Os pacientes foram randomizados em três grupos: Grupo S, que recebeu bloqueio do canal adutor com 30 mL de solução salina para controle; Grupo R, que recebeu bloqueio do canal adutor com 30 mL de ropivacaína a 0,375%; Grupo RC, que recebeu bloqueio do canal adutor com 30 mL de ropivacaína a 0,375% e 1 μg.kg−1 de clonidina. O desfecho primário do estudo foi comparar o período sem dor nos pacientes que receberam bloqueio do canal adutor com ropivacaína isolada ou ropivacina + clonidina. Os desfechos secundários foram escores de dor em repouso e movimento, necessidade total de analgésicos, escore de sedação, além de náusea e vômito no pós‐operatório. Os períodos médios sem dor foram 20 min, 384,76 min e 558,09 min para os grupos S, R e RC, respectivamente, e essa diferença foi estatisticamente significativa (p < 0,001). Não houve diferença significativa entre os grupos R e RC em termos de escores de dor em repouso e movimento e a necessidade total de analgésicos. A adição de clonidina à ropivacaína em bloqueio do canal adutor guiado por ultrassom levou a um prolongamento significativo do período sem dor, embora os escores de dor em repouso e movimento, e a necessidade de analgésico de resgate, não tenham diferido. Inadequate pain relief after anterior cruciate ligament reconstruction affects mobility leading to development of adhesions, weakened ligament insertion and muscle atrophy. Adductor canal block for postoperative analgesia preserves quadriceps strength. The present study was conducted to compare pain free period in patients undergoing arthroscopic anterior cruciate ligament reconstruction, receiving ultrasound‐guided adductor canal block with ropivacaine alone and ropivacaine with clonidine. A prospective randomized double blinded study was conducted including sixty‐three adult, ASA class I, II patients undergoing anterior cruciate ligament reconstruction. They were randomized into three groups: Group S – control group received adductor canal block with 30 mL saline, Group R – ropivacaine group received adductor canal block with 30 mL of 0.375% ropivacaine and Group RC – clonidine group received adductor canal block with 30 mL of 0.375% ropivacaine with clonidine 1 μg.kg−1. The primary aim was to compare the pain free period in patients receiving adductor canal block with ropivacaine alone or ropivacine with clonidine. The secondary outcomes were pain score at rest and movement, total analgesic requirement, sedation score and postoperative nausea and vomiting. The mean pain free periods were 20 min, 384.76 min and 558.09 min for Group S, Group R and Group RC, respectively and this difference was statistically significant (p < 0.001). There was no significant difference between Group R and Group RC in terms of pain scores at rest and movement and total analgesic requirement. Addition of clonidine to ropivacaine in USG guided adductor canal block led to significant prolongation of pain free period though pain score at rest and movement, and rescue analgesic requirement, did not differ. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Anestesiologia is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background and objectives: Arthroscopy for shoulder disorders is associated with severe and difficult to control pain, postoperatively. The addition of clonidine to local anesthetics for peripheral nerve block has become increasingly common, thanks to the potential ability of this drug to reduce the mass of local anesthetic required and to prolonging analgesia postoperatively. The present study aimed to evaluate the success of brachial plexus block for arthroscopic rotator cuff surgery using local anesthetic with or without clonidine. Method: 53 patients of both genders, between 18 and 70 years old, American Society of Anesthesiologists I or II, who were scheduled to undergo arthroscopic shoulder surgery were selected. Patients were then randomized into two groups. The verbal numerical pain scale and the presence of motor block were obtained in the post-anesthetic recovery room and 6, 12, 18 and 24 h postoperatively. Results: The association of clonidine (0.15 mg) to a solution of 0.33% ropivacaine (30 mL) in brachial plexus block for shoulder arthroscopy has not diminished the visual numeric pain scale values, nor the need for opioid rescue postoperatively. There was a lower incidence of nausea/vomiting postoperatively and a significant motor block time prolongation in the group of patients who received clonidine as adjuvant. Conclusions: The use of brachial plexus block with local anesthetic for analgesic postoperative control is well established in the literature. The addition of clonidine in the dose proposed for prolongation of the analgesic effect and reduction of opioid rescue proved unhelpful.

Resumo Introdução O tremor, problema comum no período intraoperatório sob raquianestesia, aumenta consideravelmente o consumo de oxigênio, além de ser desconfortável e angustiante para o paciente, o anestesiologista e o cirurgião. O presente estudo foi concebido para explorar a eficácia de tramadol, clonidina e dexmedetomidina no tratamento de tremores pós‐raquianestesia e observar seus efeitos adversos. Métodos Este estudo prospectivo, randômico, controlado e duplo‐cego foi feito com 90 pacientes que desenvolveram tremores sob raquianestesia. Os pacientes foram randomicamente alocados em três grupos para receber 1 mg.kg −1 de tramadol (Grupo T), 1 mcg.kg −1 de clonidina (Grupo C ) e 0,5 mcg.kg −1 de dexmedetomidina (Grupo D). O tempo necessário para controlar os tremores, a taxa de recorrência, as variáveis hemodinâmicas, os níveis de sedação e os efeitos adversos foram registrados. Resultados Dexmedetomidina foi mais rápida para controlar os tremores, com tempo de 5,7 ± 0,79 minutos (min); o tempo de tramadol foi de 6,76 ± 0,93 min; clonidina foi mais lenta, com tempo de 9,43 ± 0,93 min. A taxa de recorrência foi muito menor no grupo dexmedetomidina (3,3%) do que nos grupos clonidina (10%) e tramadol (23,3%). A sedação obtida com dexmedetomidina foi melhor do que a obtida com clonidina e tramadol. O grupo tramadol teve mais casos de vômito (quatro); o grupo dexmedetomidina teve seis casos de hipotensão e dois casos de bradicardia. Dois pacientes do grupo clonidina apresentaram bradicardia e hipotensão. Conclusão Dexmedetomidina foi melhor do que tramadol e clonidina para o controle de tremores devido ao seu início de ação mais rápido e à taxa de recorrência mais baixa. Embora complicações tenham sido observadas no grupo dexmedetomidina, elas foram tratáveis. Introduction Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects. Methods This prospective, randomized, double blinded control study was done on 90 patients who developed shivering under spinal anesthesia. They were randomly allocated into three groups with Group T receiving tramadol 1 mg.kg −1 , Group C getting clonidine 1 mcg.kg −1 and Group D patients receiving dexmedetomidine 0.5 mcg.kg −1 . The time taken to control shivering, recurrence rate, hemodynamic variables, sedation score and adverse effects were observed. Results Dexmedetomidine was faster in the control of shivering in 5.7 ± 0.79 minutes (min) whereas tramadol took 6.76 ± 0.93 min and clonidine was slower with 9.43 ± 0.93 min. The recurrence rate was much lower in the dexmedetomidine group with 3.3% than for clonidine (10%) and tramadol (23.3%) group. The sedation achieved with dexmedetomidine was better than clonidine and tramadol. The tramadol group had more cases of vomiting (four) and dexmedetomidine group had six cases of hypotension and two cases of bradycardia. Two of the clonidine patients encountered bradycardia and hypotension. Conclusion Dexmedetomidine is better than tramadol and clonidine in the control of shivering because of its faster onset and less recurrence rate. Though complications are encountered in the dexmedetomidine group, they are treatable. [ABSTRACT FROM AUTHOR]

Background and objectives: The intense trauma response triggered by cardiopulmonary bypass can lead to increased morbidity and mortality. The present study evaluated whether clonidine, a drug of the class of α-2 agonists, administered by spinal route, without association with local anesthetics or opioids, reduces this response in cardiac surgery with cardiopulmonary bypass. Method: A total of 27 patients between 18 and 75 years old, divided by non-blinded fashion into a control group (15) and a clonidine group (12), were studied. All patients underwent identical technique of general anesthesia. Then, only the clonidine group received 1 μg kg−1 clonidine by spinal route. Levels of blood glucose, lactate and cortisol were measured at three consecutive times: T1, at the time of installation of invasive arterial pressure; T2, 10 min after the first dose for cardioplegia; and T3, at the time of skin suture; and troponin I values at T1 and T3. The variation of results between T2-T1, T3-T2, and T3-T1 was also evaluated. Results: There was a statistically significant difference only with respect to the variation in blood glucose in the clonidine group: T3-T2, p = 0.027 and T3-T1, p = 0.047. Conclusions: Spinal clonidine at a dose of 1 μg kg−1 did not decrease blood measurements of troponin, cortisol, or lactate. Blood glucose suffered a more moderate variation during the procedure in the clonidine group. This fact, already reported in the literature, requires further investigation to be clarified.

O cloridrato de clonidina é um α2-adrenérgico que reduz a pressão sanguínea e retarda a estimulação cardíaca simpaticomimética. Esse fármaco é uma substância de baixo índice terapêutico que possui alta potência, sendo utilizado em baixas concentrações. Pode ser preparado em farmácias magistrais, seguindose rigorosos critérios de Boas Práticas de Manipulação estipulados pela Anvisa. Esse controle surgiu em razão de diversos acidentes possivelmente associados ao uso de cloridrato de clonidina manipulado. Diante disso, o objetivo deste trabalho foi avaliar o processo de mistura de pós na manipulação magistral da clonidina, buscando segurança e reprodutibilidade no referido processo. Para tanto, foram produzidas 60 cápsulas de cada lote, seguindo o planejamento fatorial 2³, em que foram estabelecidas as seguintes variáveis de entrada: processo de mistura (diluição geométrica e misturador Mixer Plus®), tamanho do invólucro gelatinoso (n° 03 e 02) e concentração do fármaco (0,1 e 0,2 mg). A variável resposta para o planejamento foi o teor do fármaco nas cápsulas. Além disso, foram verificados outros parâmetros de qualidade, como o peso médio e uniformidade de conteúdo. As cápsulas obtidas encontraram-se dentro dos limites especificados pelos compêndios oficiais. Por isso, os resultados sinalizam que apesar do processo de obtenção das cápsulas ser crítico é possível obter produtos com qualidade e segurança comprovada.

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), submetidos a cirurgia cardíaca, e nem reduzir ou abolir a necessidade da administração de dobutamina e nitroprussiato de sódio no intraoperatório.

Os agonistas dos receptores adrenérgicos 2 e os opioides tem ação analgésica e a aplicação preventiva pela via epidural pode minimizar os efeitos clínicos e comportamentais indesejáveis. Assim, avaliaram-se os efeitos comportamental, clínico e analgésico promovidos pela injeção epidural preventiva de morfina (0,1mg kg-1), xilazina (0,17mg kg-1) ou clonidina (3µg kg-1) durante 24 horas, em 18 equinos submetidos a um modelo incisional de dor inflamatória e avaliados pelos filamentos de von Frey. As alterações comportamentais, de frequência cardíaca, frequência respiratória, temperatura retal e altura de cabeça em relação ao solo foram mínimas e transitórias. A sensibilidade cutânea em pele incisada foi semelhante à sensibilidade da pele íntegra por 24, 8 e 12 horas após a administração epidural preventiva de morfina, xilazina ou clonidina, respectivamente, em equinos submetidos ao modelo incisional de dor inflamatória e avaliados com filamentos de von Frey. Além disso, não ocorreram alterações clínicas ou comportamentais importantes ao longo de 24 horas.Opioids and 2-agonists have analgesic effect and preventive administration by epidural route can minimize undesirable and clinical effects. So, behavioral, clinical and analgesic effects were evaluated for 24 hours after preventive epidural injection of morphine (0,1mg kg-1), xylazine (0,17mg kg-1) or clonidine (3µg kg-1) in 18 horses subjected to incisional model of inflammatory pain evaluated by von Frey filaments. Behavioral changes and changes in heart rate, respiratory rate, rectal temperature and height of head were minimum and transitory. Cutaneous sensivity in injured skin was similar to complete skin for 24, 8 and 12 hours after preventive epidural injection of morphine, xylazine and clonidine, respectively. Moreover, clinical and behavioral changes were not severe along 24 hours.

FUNDAMENTO: A sedação para a realização de cateterismo cardíaco tem sido alvo de preocupação. Benzodiazepínicos, agonistas alfa-2 adrenérgicos e opioides são utilizados para esse fim, entretanto, cada um destes medicamentos possui vantagens e desvantagens. OBJETIVO: Avaliar a eficácia do sufentanil e da clonidina como sedativos em pacientes submetidos a cateterismo cardíaco, observando o impacto dos mesmos sobre os parâmetros hemodinâmicos e respiratórios, a presença de efeitos colaterais, além da satisfação do paciente e do hemodinamicista com o exame. MÉTODOS: Trata-se de um ensaio clínico prospectivo, duplo-cego, randomizado e controlado, que envolveu 60 pacientes que receberam 0,1 µg/kg de sufentanil ou 0,5 µg/kg de clonidina antes da realização do cateterismo cardíaco. O escore de sedação segundo a escala de Ramsay, a necessidade de utilização de midazolam, os efeitos colaterais, os parâmetros hemodinâmicos e respiratórios foram registrados, sendo os dados analisados em 06 diferentes momentos. RESULTADOS: O comportamento da pressão arterial, da frequência cardíaca e da frequência respiratória foi semelhante nos dois grupos, entretanto, no momento 2, os pacientes do grupo sufentanil (Grupo S) apresentaram menor escore de sedação segundo a escala de Ramsay, e a saturação periférica da oxihemoglobina foi menor que o grupo clonidina (Grupo C) no momento 6. Os pacientes do Grupo S apresentaram maior incidência de náusea e vômito pós-operatório que os pacientes do Grupo C. A satisfação dos pacientes foi maior no grupo clonidina. Os hemodinamicistas mostraram-se satisfeitos nos dois grupos. CONCLUSÃO: O sufentanil e a clonidina foram efetivos como sedativos em pacientes submetidos a cateterismo cardíaco.

OBJECTIVES: chronic low back pain may result in central sensitization, with involvement of different receptors. The aim of this study was to evaluate the analgesic action of transdermal (T) ketamine (a NMDA antagonist), clonidine (an α2-agonist), fentanyl (an opioid agonist), or their combination in chronic low back pain. METHODS: after the institutional approval and informed consent signature, 54 patients were prospectively randomized into 6 groups. Each patient had two of the T preparations applied in different arms. The effect of either T ketamine (1 mg/h), T clonidine (25 µg/h) or T fentanyl (25 µg/h), combined with T placebo (CloG, KetG and FenG); or the combination of T ketamine and clonidine (Ket-CloG), T fentanyl and ketamine (Fen-KetG), or T fentanyl and clonidine (Fen-CloG) was searched for pain and adverse effects. Pain was evaluated by: 1) VAS pain scores, and 2) noradrenaline plasma levels at 0-h (just prior to T application), 3- and 6-h after the T application of two medications, by HPLC. RESULTS: clinically, the pain VAS score at 6-h was smaller in comparison to the 0-h in all groups (pOBJETIVOS: el dolor lumbar crónico puede resultar en sensibilización central, con la participación de diferentes tipos de receptores. El objetivo de este estudio fue evaluar la acción analgésica por vía transdérmica (T) del fentanyl, cetamina, clonidina o sus asociaciones en dolor lumbar crónico. MÉTODOS: después de la aprobación por el Comité de Ética en Investigación y Consentimiento, 54 pacientes fueron evaluados de forma prospectiva, aleatoria e duplamente-ciego siendo divididos en seis grupos. Cada paciente recibió dos preparaciones por vía transdérmica, aplicadas en brazos diferentes (T cetamina (1 mg/h), T clonidina (25 µg/h) o T fentanyl (25 µg/h), asociados a T placebo (CloG, CetG y FenG); o la asociación de T cetamina y clonidina (Cet-CloG), T fentanyl y cetamina (Fen-CetG), o T fentanyl y clonidina (fen-CloG). La analgesia y la incidencia de efectos adversos fueron evaluadas. La analgesia fue evaluada con: 1) VAS-cm, y 2) niveles plasmáticos de noradrenalina a las 0 hora (antes de la aplicación T), tres y seis horas después de la aplicación T, con HPLC. RESULTADOS: clínicamente los valores de VAS a las seis horas fueron menores comparados a 0 hora para todos los grupos (pOBJETIVOS: a dor lombar crônica pode resultar em sensibilização central, com a participação de diferentes tipos de receptores. O objetivo deste estudo foi avaliar a ação analgésica por via transdérmica (T) do fentanil, cetamina, clonidina ou suas associações para o alívio da dor lombar crônica. MÉTODOS: após aprovação do Comitê de Ética em Pesquisa e assinatura do termo de consentimento livre e esclarecido, 54 pacientes foram avaliados de forma prospectiva, aleatória e duplamente-encoberta, sendo divididos em 6 grupos. Cada paciente recebeu duas preparações por via transdérmica, aplicadas em braços diferentes (T cetamina (1 mg/h), T clonidina (25 µg/h) ou T fentanil (25 µg/h), associados a T placebo (CloG, CetG and FenG); ou a associação de T cetamina e clonidina (Cet-CloG), T fentanil e cetamina (Fen-CetG), ou T fentanil e clonidina (Fen-CloG). A analgesia e a incidência de efeitos adversos foram avaliadas. A analgesia foi avaliada com: 1) VAS-cm, e 2) níveis plasmáticos de noradrenalina às 0-h (antes da aplicação T), 3- e 6-h após a aplicação T, com HPLC. RESULTADOS: clinicamente, os valores de VAS as 6-h foram menores comparados ao tempo de 0-h para todos os grupos (p

PURPOSE: To study the safety and efficiency of two anesthetic blockages in hemorroidectomy and the effect of clonidine on analgesia. METHODS: 80 patients were studied, randomly divided into four groups: l (n=19)- peridural with a 0,75% ropivacaine; 2 (n=21)-peridural with a 0,75% ropivacaine and 150 µg of clonidine; 3 (n=19)- subarachnoid with a 0,5% bupivacaine; 4 (n=21)- subarachnoid with a 0,5% bupivacaine and 50 µg of clonidine. The intensity of pain was evaluated by the visual analogical scale 8, 12 and 24 hours after surgery. The use of vasoconstrictors on the transoperatory and the amount of analgesics within the 24 hours were registered. RESULTS: The intensity of pain, 8 hours after surgery, was lesser on group 4, and much lesser on group 4 comparing with groups 1 and 2, 12 hours (p=0,022; p=0,001) and 24 hours (p=0,03; p=0,003). The frequency of vasoconstrictors usage on the transoperatory and the analgesics on the post-operatory showed no difference among the groups. There were no anesthetic complications. CONCLUSIONS: The subarachnoid anesthesia with a 0,5% bupivacaine with clonidine, showed better analgesia comparing with the peridural anesthesia with a 0,75% ropivacaine with or without clonidine, however all were safe and efficient. The clonidine aided on the decreasing of pain when subarachnoid anesthesia was used.OBJETIVO: Verificar a segurança e a eficácia de dois bloqueios anestésicos na hemorroidectomia e o efeito da clonidina na analgesia. MÉTODOS: Foram estudados oitenta pacientes, distribuídos aleatoriamente em quatro grupos: 1 (n=19)- peridural com ropivacaína a 0,75%; 2 (n=21)-peridural com ropivacaína a 0,75% e 150 µg de clonidina; 3 (n=19)-subaranóidea com bupivacaína a 0,5%; 4 (n=21)- subaracnóidea com bupivacaína a 0,5% e 50 µg de clonidina. A intensidade da dor foi avaliada pela escala analógica visual 8, 12 e 24 horas após a cirurgia. O uso de vasoconstritores no transoperatório, o consumo de analgésicos em 24 horas foram anotados. RESULTADOS: A intensidade da dor, 8 horas após a cirurgia, foi menor no grupo 4, e significantemente menor no grupo 4 em relação aos grupos 1 e 2, 12 horas (p=0,022; p=0,001) e 24 horas (p=0,03; p=0,003). A freqüência do uso de vasoconstritores no transoperatório e de analgésicos no pós-operatório não diferiu entre os grupos. Não houve complicações anestésicas. CONCLUSÕES: A anestesia subaracnóidea com bupivacaína a 0,5%, com clonidina, apresentou melhor analgesia que a anestesia peridural com ropivacaína a 0,75% com ou sem clonidina, porém todas foram seguras e eficazes. A clonidina contribuiu para diminuir a dor na anestesia subracnóidea.

JUSTIFICATIVA E OBJETIVOS: O controle do desconforto dos pacientes internados em unidade de terapia intensiva (UTI) tem-se tornado essencial na prática da Medicina intensiva. Os fármacos sedoanalgésicos podem influenciar na morbimortalidade do paciente crítico. Agentes a2-agonistas podem ter um futuro interessante nas UTI. O objetivo deste estudo foi avaliar a administração da clonidina para a sedoanalgesia de pacientes sob ventilação mecânica (VM) prolongada. MÉTODO: Estudo de coorte histórico, onde foram selecionados os prontuários dos pacientes internados na UTI entre janeiro e dezembro de 2006, sob sedação, analgesia e ventilação mecânica por período > 7 dias. Foram anotados os dados demográficos, clínicos e terapêuticos desses pacientes, que foram subdivididos em três grupos: G1 - medicados com clonidina e outros sedoanalgésicos, G2 - medicados com mais de três fármacos sedoanalgésicos, exceto clonidina, e G3 - medicados com midazolam e fentanil. Registrou-se a dose média diária da clonidina, anotando-se, antes da sua administração, 6 e 24 horas após, os valores da freqüência cardíaca e pressão arterial. Para a análise estatística foram utilizados os testes Análise de Variância (ANOVA), t de Student, c² sendo considerado significativo quando p < 0,05. RESULTADOS: Foram avaliados 55 pacientes. Quinze (27,3%) pertenciam ao G1, 11 (20%) ao G2, 29 (52,7%) ao G3. A idade média dos pacientes foi 44 (G1), 50 (G2) e 55 (G3) anos (p = NS). O índice APACHE II médio dos grupos foi 18 (G1), 20,4 (G2), 20,7 (G3) (p = NS). Os pacientes do G1 e G2 permaneceram mais tempo internados na UTI e no hospital (p < 0,05). A dose média administrada de clonidina foi 1,21 ± 0,54 mg/kg/h. Houve diminuição da freqüência cardíaca e da pressão arterial nos pacientes do G1. Esses efeitos não tiveram repercussão clínica nem relação com a dose da clonidina. A mortalidade foi significativamente menor nos pacientes do G1 (20%) em comparação com os do G2 (54,5%) e do G3 (62%). CONCLUSÕES: A administração da clonidina não acarretou efeitos colaterais importantes nos pacientes estudados. A taxa de mortalidade dos pacientes medicados com clonidina foi significativamente menor.BACKGROUND AND OBJECTIVES: The control of patient discomfort in the intensive care unit (ICU) has become an integral part of critical care practice. The sedoanalgesic drugs could influence critically ill patient's morbimortality. Alpha²-adrenoceptor agonists might have an interesting future in ICU. The objective of this study is to evaluate the clonidine use for sedoanalgesia in ICU patients under prolonged mechanical ventilation. METHODS: Historical cohort study. Admitted patient files, January-December 2006, which stayed under mechanical ventilation, analgesia and sedation > 7days were analyzed. Demographic, clinical features and therapeutic data concerning analgesia and sedation were remarked. The data allowed classify the patients in three different groups: G1 = patients that used clonidine and other drugs; G2 = patients that used three or more drugs, without clonidine and G3 = patients that used fentanyl and midazolam. The mean daily doses of infused clonidine were registered, and the values of heat rate (HR), blood arterial pressure (BAP) before starting use of clonidine, after six hours and 24 hours were also registered. Statistical analyzes were performed using Variance Analysis (ANOVA), t tests and x² (significance p < 0.05). RESULTS: Were selected 55 patients. Fifteen (27.2%) belonged to G1, 11 (20%) belonged to G2 and 29 (52.7%) belonged to G3. The mean age of patients was 44 (G1), 50 (G2) and 56 (G3) (p = NS). The mean score APACHE II was 18 (G1), 20.4 (G2) and 20.7 (G3) (p = NS). G1 and G2 patients presented higher ICU length-of-stay (p < 0.05). The mean dose of clonidine used was 1.21 ± 0.54 mg/kg/min. G1 patients had HR and BAP decreased, however these effects were not considered clinically relevant. The mortality was lower in the patients from G1 (20%) when compared to G2 (54.5%) and G3 (62%) (p < 0.05). CONCLUSIONS: The clonidine use to analyzed patients did not result in clinical relevant side effects. The lower mortality index in patients that used clonidine was statistical significant.

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.

JUSTIFICATIVA E OBJETIVOS: A síndrome de abstinência tem alta prevalência em nosso meio e, além do desconforto, prolonga o tempo de internação. O objetivo deste estudo foi avaliar a influência da adição de clonidina por via oral, à infusão contínua de morfina e midazolam na sedação de crianças submetidas à ventilação mecânica. MÉTODO: Foi realizado um estudo aleatório, duplamente encoberto e placebo controlado na UTI Pediátrica do Hospital Geral de Caxias do Sul, no período de maio de 2005 a agosto de 2006. Foram Incluídas crianças com idade entre 1 e 36 meses, submetidas à ventilação mecânica por mais de 12 horas, que utilizaram morfina e midazolam em infusão contínua. Foram divididas em dois grupos: clonidina (5 µg/kg) e placebo, associados à infusão de morfina e midazolam. As doses dos sedativos em infusão contínua foram definidas pelos médicos assistentes. Diariamente foram registradas as doses de sedativos administradas nas 24 horas, assim como as doses intermitentes e aplicado o escore de Finnegan para definir e quantificar abstinência. Os grupos foram comparados quanto às doses de sedativos administradas, tempo de uso de infusão contínua, presença e duração da abstinência. RESULTADOS: Foram incluídas 69 crianças (31 no grupo clonidina e 38 no placebo). Os grupos foram semelhantes nas características gerais (peso, idade, sexo, indicação de ventilação mecânica). Ambos os grupos utilizaram altas doses cumulativas de sedativos, tanto em infusão contínua quanto intermitente. Completaram o estudo 59 pacientes, 25 no grupo clonidina e 34 no placebo. Em ambos os grupos a prevalência da abstinência foi semelhante (72% e 75%, respectivamente), sem diferença na sua duração e no tempo de ventilação mecânica. CONCLUSÕES: Em crianças submetidas à ventilação mecânica que utilizaram altas doses de opióides e diazepínicos, a adição de clonidina não promoveu redução nas doses diárias ou cumulativas de sedativos, não influiu na prevalência ou na evolução da abstinência.BACKGROUND AND OBJECTIVES: In our country, the abstinence syndrome has high prevalence and besides the distress prolongs the length of hospital stay. The aim of this study was to evaluate the influence of associating oral clonidine to the intravenous morphine plus midazolam continuous infusion in children submitted to mechanical ventilation. METHODS: Randomized, double blind, placebo controlled study, conducted in the PICU at the Hospital Geral of Caxias do Sul. All children (1-36 months) submitted to mechanical ventilation over 12 hours (May-2005/August-2006), which had used intravenous morphine and midazolam continuous infusion were included. They were randomized to received clonidine (5 µg/kg) or placebo associated to the sedative continuous infusion. The infusion sedative doses were at the discretion of the assistant physician. The administered doses in the previous 24 hours and the doses of intermittent sedation were daily collected. The abstinence syndrome was defined based on Finnegan Score. The groups were compared regarding the cumulative doses of sedatives, length of use of sedative continuous infusion, presence and duration of the abstinence. RESULTS: Were included 69 patients (31 in the clonidine group and 38 in the placebo group). The two groups were similar regarding the general characteristics (weight, age, gender, indication of mechanical ventilation). The midazolam and morphine doses (cumulative and intermittent doses) were not different in both groups. Completed the study 59 patients, 25 in clonidine group and 34 in placebo group. The prevalence of the abstinence was similar (72% and 75%, respectively), without difference in the recovery time neither related to the length of mechanical ventilation. CONCLUSIONS: In children submitted to mechanical ventilation using high dose of opioids and diazepinic infusion the addiction of clonidine did not decrease the daily doses neither the cumulative doses and nevertheless reduced the prevalence and the evolution of abstinence syndrome.

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 µg/kg desta droga, e o grupo controle que utilizou solução fisiológica a 0,9%. 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 (pOBJECTIVE: 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 µg/kg dose of this drug and the control group, that were administered a 0.9% 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

Resumo Justificativa e objetivos A artroscopia para afecções do ombro associa‐se a dor de forte intensidade no pós‐operatório, de difícil manejo. A adição de clonidina ao anestésico local em bloqueios periféricos tornou‐se progressivamente maior graças à potencial habilidade dessa droga em reduzir a massa de anestésicos locais necessários e prolongar a analgesia no pós‐operatório. O presente estudo teve como objetivo avaliar o sucesso do bloqueio de plexo braquial para a cirurgia artroscópica de manguito rotador com o uso de anestésico local associado ou não à clonidina. Método Foram selecionados 53 pacientes de ambos os sexos, entre 18 e 70 anos, ASA I ou II , que seriam submetidos à cirurgia de ombro por artroscopia. Os pacientes foram então randomizados em dois grupos. A escala numérica verbal de dor e a presença de bloqueio motor eram obtidas na sala de recuperação pós‐anestésica (SRPA) e com seis, 12, 18 e 24 horas de pós‐operatório. Resultados A associação de clonidina (0,15 mg) à solução de ropivacaína 0,33% (30 mL) no bloqueio de plexo braquial para artroscopia de ombro não diminuiu os valores da escala visual numérica de dor, nem a necessidade de resgate com opioides no pós‐operatório. Houve uma menor incidência de náuseas e vômitos no pós‐operatório (NVPO) e aumento considerável do tempo de bloqueio motor no grupo de pacientes que recebeu clonidina como adjuvante. Conclusões O uso do bloqueio de plexo braquial com anestésico local para controle analgésico pós‐operatório está consolidado na literatura. A adição de clonidina na dose proposta para prolongamento do efeito analgésico e redução de resgate com opioides mostrou‐se pouco útil. Background and objectives Arthroscopy for shoulder disorders is associated with severe and difficult to control pain, postoperatively. The addition of clonidine to local anesthetics for peripheral nerve block has become increasingly common, thanks to the potential ability of this drug to reduce the mass of local anesthetic required and to prolonging analgesia postoperatively. The present study aimed to evaluate the success of brachial plexus block for arthroscopic rotator cuff surgery using local anesthetic with or without clonidine. Method 53 patients of both genders, between 18 and 70 years old, ASA I or II , who were scheduled to undergo arthroscopic shoulder surgery were selected. Patients were then randomized into two groups. The verbal numerical pain scale and the presence of motor block were obtained in the post‐anesthetic recovery room and six, 12, 18 and 24 hours postoperatively. Results The association of clonidine (0.15 mg) to a solution of 0.33% ropivacaine (30 mL) in brachial plexus block for shoulder arthroscopy has not diminished the visual numeric pain scale values, nor the need for opioid rescue postoperatively. There was a lower incidence of nausea/vomiting postoperatively and a significant motor block time prolongation in the group of patients who received clonidine as adjuvant. Conclusions The use of brachial plexus block with local anesthetic for analgesic postoperative control is well established in the literature. The addition of clonidine in the dose proposed for prolongation of the analgesic effect and reduction of opioid rescue proved unhelpful. [ABSTRACT FROM AUTHOR]

Avaliaram-se as alterações cardiorrespiratórias e a analgesia da administração epidural de clonidina ou romifidina em cães submetidos à cirurgia coxofemural. Foram utilizados 14 cães distribuídos em dois grupos: o grupo Cloni recebeu 150µg de clonidina e o grupo Romi, 20µg/kg de romifidina. A indução anestésica foi realizada com propofol e a anestesia cirúrgica mantida com halotano e O2 em respiração espontânea. A punção do espaço epidural foi feita logo após a indução. Antes da indução e a cada 10 minutos foram avaliadas as freqüências cardíaca e respiratória, a pressão arterial sistólica, a saturação de oxigênio da hemoglobina e a concentração de halotano. Após indução e ao término do procedimento cirúrgico coletou-se sangue arterial para avaliação gasométrica de pH, PaCO2, PaO2, SaO2, BE e HCO3-. Foi realizada avaliação pós-operatória do grau de analgesia (intensa, pouco intensa e inadequada) nas primeiras duas horas após término da cirurgia. Os animais do grupo Romi apresentaram bradicardia, bradiarritmias e hipertensão. A freqüência cardíaca e a pressão arterial sistólica no grupo Cloni mantiveram-se dentro da faixa de variação fisiológica para a espécie. A analgesia trans-operatória foi considerada intensa nos dois grupos. A administração epidural de clonidina ou romifidina produziu intensa analgesia transcirúrgica sem depressão respiratória e pouco intensa analgesia pós-operatória por duas horas

Se realizó un estudio de tipo ensayo clínico-terapéutico, comparativo y prospectivo, aleatorizado y a ciegas, para evaluar la eficacia de la clonidina de producción nacional por vía intratecal en combinación con otros agentes, para el alivio del dolor posoperatorio (PO) y describir los efectos adversos atribuibles a su uso. Se seleccionaron a 100 pacientes programados para cirugía proctológica. Se conformaron 4 grupos de 25 casos: lidocaína hiperbárica (G-1), lidocaína hiperbárica más fentanyl (G-2), lidocaína hiperbárica más clonidina (G-3), lidocaína hiperbárica más fentanyl más clonidina (G-4). El tiempo de analgesia PO más prolongado se logró en G-4, también en él ningún paciente refirió dolor severo. El tiempo de analgesia menor se encontró en G-1, así como la mayor cantidad de pacientes con dolor severo. La hipotensión transoperatoria y la retención urinaria PO fueron los efectos adversos más frecuentes, aunque no significativos.A clinicotherapeutic comparative and prospective randomised blind study was conducted to evaluate the efficacy of clonidine of national production administered by intrathecal route in combination with other agents to relieve postoperative pain (PP) and to describe the adverse effects attributable to its use. 100 patients that were scheduled to undergo proctological surgery were selected and divided into 4 groups of 25 cases each: hyperbaric lidocaine hydrochloride (G-1), hyperbaric lidocaine hydrochoride plus fentanyl (G-2), hyperbaric lidocaine hydrochloride plus clonidine (G-3), and hyperbaric lidocaine hydrochloride plus fentanyl plus clonidine (G-4). The longest analgesia time (AT) was attained in G-4 and no patient had acute pain in this group. The lowest analgesia time was found in G-1 , as well as the highest number of patients with acute pain. Transoperative hypotension and postoperative retention of urine were the commonest adverse effects, although they were not significant.

Se estudiaron los efectos analgésicos de los siguientes fármacos por vía extradural: epinefrina 0,1 mg, clonidina 0,15 mg, fentanyl 0,15 mg, morfina 2 mg y morfina 2 mg más clonidina 0,15 mg, todos añadidos a la bupivacaína 0,5, 20 mL (100). Un total de 145 pacientes fueron estudiados en forma prospectiva. El análisis estadístico se practicó mediante análisis de varianza y se compararon los tiempos de analgesia máxima y las reacciones indeseables. La clonidina superó al fentanyl en este objetivo, pero su inclusión a la mezcla bupivacaína/morfina sólo incrementó la incidencia de efectos indeseables. En este estudio resultó mejor la asociación de bupivacaína 0,5 % y morfina 2 mgThe analgesic effects of the following drugs by extradural route were studied: epinephrine 0.1 mg, clonidine 0.15 mg, fentanyl 0.15 mg, morphine 2 mg, and morphine 2 mg plus clonidine 0.15 mg, all of them added to bupivacaine 0.5 20 mL (100). A total number of 145 patients were studied in a prospective way. The statistical analysis was applied by the analysis of variance and the times of maximal analgesia and undesirable reactions were compared. Clonidine was to be better than fentanyl for this objective, but its inclusion to the mixture of bupivacaine/morphine only increased the incidence of adverse effects. It is concluded that the best combination was bupivacaine 0.5 % and morphine 2 mg

Se realizó un ensayo terapéutico prospectivo y doble ciegas en 60 pacientes con criterios de urgencia hipertensiva, se comparó la efectividad así como el tipo y frecuencia de reacciones adversas del clorhidrato de clonidina con el calcio antagonista nifedipina, con una dosis horaria de 0,15 mg y 10 mg, respectivamente, durante un período de observación de 3 horas. Se controló la urgencia en el 96,6 % del grupo clonidina y el 90 % del grupo nifedipina. Más del 60 % de la casuística refirió efectos colaterales, aunque sin relevancia clínica. Se confirmó una significativa diferencia estadística en la presentación de la cefalea con el uso de la nifedipina (p=0,01) y de la somnolencia (p=0,004) y la xerostomía (p=0,01) con el uso de la clonidina. No hubo casos de hipotensión ortostática (HO) sintomática. Hubo un mayor número de casos de HO asintomática en el grupo clonidina, en comparación con el de nifedipina (30 % versus 16 %), aunque estadísticamente sin diferencias significativas. Los efectos sedantes del alfa 2 agonista fueron comunes (63 %), pero no interfirieron con el examen neurológico de los pacientes ni limitaron su eficacia terapéutica. No ocurrieron accidentes coronarios o cerebrovasculares durante el período de observación.A prospective, therapeutic and double blind assay was perfomed in 60 patients with clinical criteria of hypertensive emergency, the effectiveness, as well as the type and frequency of adverse reactions of clonidine hydrochloride were compared with the ones of nifedipine, a calcium antagonist, using a dosage of 0.15 mg and 10 mg, respectively, during a 3-hours observations period. The hypertensive emergency was controlled in 96.6 % of the group treated with nifedipine. More than 60 % of the casuistic group reported side effects, but with no clinical significance. A statistically significant differences was confirmed regarding the occurrence of headache with the use of nifedipine (p = 0,01), and the occurrence of drowsiness (p = 0,004) and xerostomia (p = 0,01) with the use of clonidine. There were no cases of symtomatic orthostatic hypertension. A greater number of cases presenting with asymptomatic orthostatic hypertension were found in the group receiving clonidine compared with the group receiving nifedipine (30 % vs 16 %), although there were no statistically significant differences. The sedative effects of alpha-2 agonist were common (63 %) but such effects neither interfere with the neurologic examination of the patients nor limited its therapeutic efficacy. No coronary or cerebral stokes occurred during the observation period.

Se diseña un estudio para evaluar la introducción de la clonidina en la terapéutica de la urgencia hipertensiva en nuestro país, con un estudio a doble ciegas en el que se usó la nifedipina como medicamento de control. Se trataron 60 pacientes aleatoriamente con una dosis horaria de 0,15 mg de clonidina o 10 mg de nifedipina por vía oral, en un ensayo prospectivo. No hubo diferencias estadísticamente significativas entre ambos grupos respecto a la edad, sexo y tensión arterial diastólica inicial. Se obtuvo una buena respuesta después de un período de observación de 3 horas en el 96,6 % del grupo tratado con clonidina y en el 90,0 % del grupo tratado con nifedipina. La ganancia tensional diastólica a los 120 minutos fue de 27,6 mmHg (nifedipina) y de 31,3 mmHg (clonidina). En ambos grupos la frecuencia del pulso disminuyó en el tiempo. No se apreció influencia estadísticamente significativa de las variables número de dosis recibidas, tipo de medicación o reducción de la tensión arterial sobre la disminución del pulso radial, aunque fue mayor (p = 0,06) con el uso de la clonidina. Los efectos sedantes del alfa agonista, aunque comunes, no fueron de importancia clínica.A study was designed to evaluate the introduction of clonidine for the therapy of hypertensive emergencies in our country, in a double-blind study with the use of nifedipine as control drug. A number of 60 patients were randomly treated with a dose of 0.15 mg of clonidine or 10 mg of nifedipine by oral route in a prospective assay. There were no statistically significant differences between both groups regarding age, sex and baseline diastolic blood pressure. A good response was obtained after an observational period of 3 hours in 96.6 % of patients treated with clonidine, and in 90.0 % of cases treated with nifedipine. The diastolic pressure gain at 120 minutes was 27.6 mm Hg (nifedipine) and of 31.3 mm Hg (clonidine). The pulse rate decreased with the time in both groups. No statistically significant influence was observed with respect to the variables such as the number of doses received, type of drug or reduction of blood pressure on the reduction of the radial pulse, although it was greater (P = 0.06) with the use of clonidine. The sedative effects of the alpha agonist, however bling common, were not relevant from the clinical point of view.

Resumo Justificativa e objetivos A intensa resposta ao trauma desencadeada pela circulação extracorpórea pode conduzir ao aumento da morbimortalidade. O presente estudo avaliou se a clonidina, fármaco da classe dos α‐2 agonistas, por via raquidiana, sem associação com anestésicos locais ou opioides, reduz essa resposta em cirurgias cardíacas com uso de circulação extracorpórea. Método Estudaram‐se 27 pacientes entre 18 e 75 anos, separados de modo não encoberto em grupo controle (15) e grupo clonidina (12). Todos foram submetidos a técnica idêntica de anestesia geral. A seguir, apenas o grupo clonidina recebeu 1 mg.kg −1 de clonidina por via raquidiana. Foram dosados os valores de glicemia, lactato e cortisol em três tempos consecutivos: T1, no momento da instalação da pressão arterial invasiva (PAM); T2, dez minutos após a primeira dose de cardioplegia; e T3 na sutura da pele, bem como os valores de troponina I em T1 e T3. Avaliou‐se também a variação dos resultados entre: T2‐T1; T3‐T2 e T3‐T1. Resultados Houve diferença estatisticamente significativa apenas quanto à variação da glicemia no grupo clonidina: T3‐T2 valor de p=0,027 e T3‐T1 valor de p = 0,047. Conclusões A clonidina espinhal em dose de 1 μg.kg −1 não diminuiu as dosagens sanguíneas de troponina, cortisol ou lactato. A glicemia sofreu uma menor variação durante o procedimento no grupo clonidina. Esse fato, já registrado na literatura, necessita de maiores investigações para ser esclarecido. Background and objectives The intense trauma response triggered by cardiopulmonary bypass can lead to increased morbidity and mortality. The present study evaluated whether clonidine, a drug of the class of α‐2 agonists, administered by spinal route, without association with local anesthetics or opioids, reduces this response in cardiac surgery with cardiopulmonary bypass. Method A total of 27 patients between 18 and 75 years old, divided by non‐blinded fashion into a control group (15) and a clonidine group (12), were studied. All patients underwent identical technique of general anesthesia. Then, only the clonidine group received 1 μg kg −1 clonidine by spinal route. Levels of blood glucose, lactate and cortisol were measured at three consecutive times: T1, at the time of installation of invasive arterial pressure; T2, 10 min after the first dose for cardioplegia; and T3, at the time of skin suture; and troponin I values at T1 and T3. The variation of results between T2–T1, T3–T2, and T3–T1 was also evaluated. Results There was a statistically significant difference only with respect to the variation in blood glucose in the clonidine group: T3–T2, p = 0.027 and T3–T1, p = 0.047. Conclusions Spinal clonidine at a dose of 1 μg kg −1 did not decrease blood measurements of troponin, cortisol, or lactate. Blood glucose suffered a more moderate variation during the procedure in the clonidine group. This fact, already reported in the literature, requires further investigation to be clarified. [ABSTRACT FROM AUTHOR]

Clonidine hydrochloride is an α2-adrenergic agonist that reduces the blood pressure and delays cardiac sympathomimetic stimulation. This drug has a low therapeutic index, high potency and is commonly used at low concentrations. It can be prepared at compounding pharmacies, as long as the rigorous criteria of Good Handling Practices stipulated by Anvisa are followed. This control had its origins in several accidents possibly associated with the use of compounded clonidine hydrochloride. In this context, the present study was designed to assess the powder-mixing process during the compounding of clonidine, so as to optimize its safety and repeatability. To this end, 60 capsules were produced in each batch, following 23 factorial planning, using the following input variables: mixing process (geometric dilution or Mixer Plus®), size of gelatin shell (number 03 or 02) and drug concentration (0.1 and 0.2 mg). The response variable for the planning was the amount of drug inside the capsules. In addition, other quality parameters were determined, such as the average weight and content uniformity. The capsules produced were within the limits specified by official compendia. Therefore, the results indicate that, although the process of compounding capsules is critical, it is possible to have products with assured quality and safety. [ABSTRACT FROM AUTHOR]

Resumo 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 ou abolição 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 dobutamina e nitroprussiato de sódio em quatro momentos: (M 0 ) antes da administração de 2 μg/kg de clonidina 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 pulmonar em 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), submetidos a cirurgia cardíaca, e nem reduzir ou abolir a necessidade da administração de dobutamina e nitroprussiato de sódio no intraoperatório. [ABSTRACT FROM AUTHOR]

O objetivo deste trabalho foi investigar a variação na secreção de GH em resposta ao tratamento com clonidina, agonista alfa-2 adrenérgico, no período pré-púbere de novilhas da raça Nelore, e desta forma obter informações neuroendócrinas envolvidas no processo de maturação sexual destes animais. A administração de clonidina (10 µg/kg, I.V., amostras 15 min por 4h) foi feita nas novilhas aos oito (n =4), 12(n = 5) e 15 meses de idade (n = 4). A concentração de GH foi quantificada por radioimunoensaio (sensibilidade = 0,25 ng/mL, CV = 16%). Aos oito meses, a administração do estimulador alfa-2 adrenérgico aumentou a concentração de GH, área total de picos, área total de secreção de GH e amplitude do maior pico e reduziu o tempo para aparecimento de pico (P < 0,05). A administração de clonidina aumentou a concentração de GH aos 15 meses, e aos 12 meses, em intervalos restritos (P < 0,05). O uso da clonidina estimulou a secreção de GH em novilhas Nelore pré-púberes. Este efeito foi mais evidente nas novilhas aos oito meses, comparado aos 12 e 15 meses de idade.

Constitutional delayed growth (CDG) is defined as that condition in which height is below the third percentile in Tanner Whitehouse growth curves, associated to a similar delay in skeletal maturity (Greulich and Pyle Atlas), and to the absence of deficiencies of Growth and Thyroid hormones or of nutritional and psychosocial conditions. The subjects of this study were 15 boys and 6 girls (age 13.4 :t: 3.1 years, range 10.9-16). Thirteen boys and 1 girl were at a prepuberal stage of development at the beginning of the study. In order to check the spontaneous growth velocity (GV), the patients were followed for a four-month period before starting any treatment. The boys under 13 years and all the girls received clonidine during a 4-12 month period (0.1 mg/m2/day). With this drug the boys Increased their GV from 5.9 :t 3.12 cm/year to 7.04 :t 2.23 cm/year (NS), and the girls from 5.53 :t 2.31 to 6.45 :t 1.18 cm/year (NS). However, two subgroups were clearly differentiated: the children who had some response to clonidine and those who did not. In the boys that responded, the spontaneous GV before clonidine was significantly less than that of those who did not respond (3.8 :t 3.27 vs 7.67 :t 1.66 cm/year) (P< 0.05). The figures for the girls were 3.5 :t 0.86 and 7.57 :t 0.4 cm/year, respectively (P< 0.01 ). Nine boys received Testosterone Enantate (250 mg I.M./month for four doses); five of them had previously received clonidine. The GV before Testosterone, 5.0 :t 2.59 compared to post-testosterone, 9.26 :t 2.4 cm/year was significantly lower (P< 0.01 ). The delay In skeletal maturation, as defined by the bone age/chronological age Index, dld not have any bearing on the eventual response to clonldine, nor this response was attributable to a progress In the sexual maturity index (Tanner) during treatment with clonidine. We conclude that a subnormal spontaneous GV (Iess than 4 cm/year) in these children may have a predictive value for an eventual response to clonidine treatment. Yet, more cases need to be studied to be able to draw finer conclusions. Los sujetos de este estudio fueron 15 niños y 6 niñas con retraso constitucional del crecimiento (edad 13.4 :t 3.1 años, rango 10.9-16). Trece niños y una niña se encontraban en la etapa prepuberal al Iniciar el estudio. Con el fin de observar la velocidad de crecimiento (VC) espontánea, los pacientes fueron seguidos por un periodo de cuatro meses antes de Iniciar el tratamiento. Los niños menores de 13 años y todas las niñas recibieron clonidina durante 4 a 12 meses (0.1 mg/m2/día). Con ésta, el grupo de niños Incrementó su velocidad de crecimiento de 5.9 :t 3.12 a 7.04 :t 2.23 cm/año y las niñas de 5.53 :t 2.31 a 6.45 :t 1.18 cm/año (Ns). Sin embargo, hubo dos grupos claramente discernibles: los que respondieron a la clonidina y los que no lo hicieron. En los niños que respondieron la VC espontánea antes de la clonidina fue significativamente menor que la de los que no respondieron (3.8 :t 3.27 vs. 7.67 :t 1.66 cm/año) ( p < 0.05). Para las niñas las cifras fueron 3.5 :t 0.86 y 7.57 :t 0.4 cm/año, respectivamente (p < 0.01 ). Nueve niños recibieron enantato de testosterona (250 mg IM/mes por cuatro dosis); cinco de ellos hablan recibido clonidina previamente. La VC antes de la testosterona (5.0 :I: 2.59 cm/año) en comparación con post- testosterona (9.26 :I: 2.4 cm/año) ,fue significativamente menor (p < 0.01 ). El retraso de la maduración esquelética definido por el indice edad ósea/edad cronológica no influyó en la respuesta eventual a la clonidina, ni tal respuesta fue atribuible a un incremento en el índice de maduración sexual (Tanner) durante el tratamiento con esta droga. Se concluye que una velocidad de crecimiento espontánea subnormal (menos de 4 cm/año) parece tener un valor predictivo para una eventual respuesta de estos niños a la clonidina. Se necesita un mayor número de casos para conclusiones más definitivas.

Introduction: Spinal anesthesia has been part of the pediatric anesthesia practice for more than 100 years. Its use has been increasing in recent years because of its effectiveness, efficiency and safety. We report a successful case in a patient with a difficult airway. Objective: To report a case of spinal anesthesia and sedation with remifentanil, together with a review of the literature including alpha 2 agonists for locoregional procedures in pediatrics. Methods: Search of relevant references in PubMed, MD consult and BIREME. The search resulted in 306 articles, and 23 considered relevant by the authors were finally selected. Results: We present a case of a 1-year-old boy with an expected difficult airway because of the presence of a cavernous hemangioma of the lower lip, scheduled for surgical correction of bilateral club foot. Spinal anesthesia consisted of 0.5% hyperbaric carbonated bupivacaine plus 30 μg of clonidine (1.3 ml total), maintaining sedation-analgesia at 3-4/6 on the Ramsay scale with remifentanil 0.05-0.075 μg/kg/min, 50% oxygen with facial mask, and spontaneous ventilation, with no hemodynamic or respiratory adverse effects. Conclusions: Spinal anesthesia is an option in cases of predicted difficult airway. Clonidine (alpha 2 agonist) prolongs blockade with no hemodynamic or respiratory complications. Remifentanil used for sedation in pediatric locoregional procedures is easy to titrate with predictable results. [ABSTRACT FROM AUTHOR]

Copyright of Colombian Journal of Anesthesiology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Nacional de Odontología is the property of Universidad Cooperativa de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Epidural administration of opioids and α2-adrenergic agonists allows the use of smaller doses when administered by other routes, providing analgesia during trans and post-anesthetic periods, reducing side effects and postoperative stress. Sufentanil in higher doses caused minimal hemodynamic changes in dogs. When given epidurally, clonidine produces analgesia without motor block by a non-opioid mechanism of action. The aim of this study was to evaluate the quality and duration of analgesia as well the cardiorespiratory changes resulting from administration of epidural clonidine or sufentanil in dogs anesthetized with halothane. Materials, Methods & Results: Twenty adult health dogs were used divided into two groups, clonidine (CLO) group and sufentanil (SUF) receiving 150 µg and 50 µg respectively epidural. After induction with thiopental and propofol in a mixture of equal parts (0.8 mg/kg), general anesthesia was maintained with halothane in a Bain circuit for further epidural administration of drugs. Heart rate and cardiac rhythm, respiratory rate, tidal volume, min volume, systolic arterial pressure, body temperature, oxygen saturation of oxyhemoglobin, halothane vaporization were evaluated at times T0 (baseline) and every 15 min until the end of the procedure (T1, T2, T3, T4). The arterial blood gas analysis was performed at T0G (baseline) and 30 min and 2 h after epidural (T1G, T2G) evaluating pH, PaO2, PaCO2, BE, HCO3 - and TCO2. Postoperative analgesia was assessed by the scale of Firth & Haldane (1999) every hour for five hours, starting one hour after the surgery. All parametric variables were analyzed by use of a 1-way ANOVA for repeated measures, followed by a Dunnet test to compare all sample collection times with baseline data (0 min). For comparisons among groups, for each time, test t was used. Differences were considered significant when P < 0.05. The results showed a significant reduction in heart rate after 15 min lasting for 60 min with a reduction in SAP, but no signs of hypotension. A reduction in respiratory rate was also observed in the SUF group and vaporization of halothane in both groups with increase in SpO2. There was no difference in cardiac rhythm and tidal volume, there was only an increase in minute volume at 60 min in the SUF group. Body temperature also decreases at all times. Discussion: The reduction in heart rate was observed since sufentanil have discrete sympatholytic and vagotonic activity and α2-adrenergic agonists may also cause bradycardia by vagomimetic effect. The drugs used can also cause a reduction in blood pressure, but hypotension was not observed in this study, corroborating with several authors. The lipophilic opioids suffer greater absorption by the blood vessels in the epidural region resulting in peak plasma concentration and early respiratory depression, while the α2-adrenergic agonists cause respiratory depression secondary to central nervous system depression. The observed reduction in vaporization is due to potentiation of drugs used. Analgesia in the intraoperative period can be proved since tachycardia, tachypnea, or hypertension during clamping of the ovarian pedicles was not observed and in the immediate postoperative period, both drugs proved effective with Firth & Haldane numerical scale. The doses employed by epidural reduced the need for halothane demonstrating intra-operative analgesic effect. Furthermore, sufentanil caused severe respiratory depression, however it is suggested greater efficacy when compared to clonidine in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Opioids and α2-agonists have analgesic effect and preventive administration by epidural route can minimize undesirable and clinical effects. So, behavioral, clinical and analgesic effects were evaluated for 24 hours after preventive epidural injection of morphine (0.1mg kg-1), xylazine (0.17mg kg-1) or clonidine (3mg kg-1) in /8 horses subjected to incisional model of inflammatory pain evaluated by von Frey filaments. Behavioral changes and changes in heart rate, respiratory rate, rectal temperature and height of head were minimum and transitory. Cutaneous sensivity in injured skin was similar to complete skin for 24, 8 and 12 hours after preventive epidural injection of morphine, xylazine and clonidine, respectively. Moreover, clinical and behavioral changes were not severe along 24 hours. [ABSTRACT FROM AUTHOR]

Background: α2-adrenergic agonists stand out for their intense acting in the respiratory and hemodynamic parameters, which sometimes aggravates the already compromised patient. Clonidine is widely used in humans due to its sedation, minimal hemodynamic and respiratory changes and for analgesia. In veterinary medicine, clonidine has been studied recently specially for epidural analgesia. The study aimed to evaluate the physiological changes and the sedative effect of the intramuscular administration of clonidine in dogs, once there are no reports of intramuscularly use of clonidine. Materials, Methods & Results: Six adult healthy mongrel dogs (5 females and 1 male) were used, after hematological evaluation (complete hemogram) with an average weight of 12 ± 2.5 kg. The animals were randomly divided into four groups with a minimum interval of 10 days, where: control group (GC) received 5 mL of saline IM with the other three groups receiving different doses of clonidine, 5 µg/kg (CLO5), 15 µg/kg (CLO15) and 30 µg/kg (CLO30) intramuscularly. Heart and respiratory rate, oxygen saturation, systolic arterial pressure, rectal temperature and sedation by analogical descriptive scale were evaluated before administration (baseline), after 5 and 15 min and at 15 min intervals for a period of 90 min. For each group, all parametric variables were analyzed by use of a 1-way ANOVA for repeated measures, followed by a Dunnet test to compare all sample collection times with baseline data (0 min). For comparisons among groups, for each time, 1-way ANOVA was performed, followed by a Tukey test. Score sedation non parametrical variable were analyzed by Friedman test, followed by Dunn's. Differences were considered significant at P < 0.05. The results showed that clonidine caused a reduction in heart rate 5 min after administration lasting for 90 min with the three doses studied, with a reduction in systolic arterial pressure but with no signs of hypotension. There were respiratory reduction, but between normal values and decreased rectal temperature was observed, with no changes in oxygen saturation. Sedation scores were higher with the higher doses of clonidine. Discussion: The cardiovascular and respiratory effects of administration of α2-adrenergic agonists are characteristic, noting reduction in heart rate which is due mostly to decrease in sympathetic nervous system tonus, which was observed in all treated groups where a significant reduction in heart rate in a gradual manner and tending to be dose dependent since lower values were observed with higher doses, reaching bradycardia (HR <60 bpm) in group CLO30. Another common alteration of α2-adrenergic agonists are the changes in blood pressure, such as hypertension and subsequent hypotension and respiratory depression, frames not observed in this study. Reduction in body temperature is especially due to decrease in muscular activity as well interfering with thermoregulatory mechanisms. Another factor that may contribute is the room temperature, which remained close to 25 C. Intramuscular administration of clonidine caused light and mild sedation with the studies doses and cardiorrespiratory changes should be used in healthy animals. Further studies should be conducted with associations of other pharmacological class to promote a more pronounced level of sedation. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of caudal block with clonidine/ bupivacaine versus caudal block with bupivacaine alone. Methods: The study was conducted with forty-six children, aged 1 to 8 years scheduled for open reduction of the hip in ASA physical status I-II. Inhalatory sedation was with sevoflurane (4.0 vol%); Group I caudal block was with bupivacaine 0.25% 1.4 mL/kg and group 2 caudal block was with clonidine 2 µg/kg plus bupivacaine 0.25% 1.4mL/kg. Anesthesia was maintained with sevoflurane 10-1.5 vol%. Results: The duration of surgery and anesthesia were the same. Group 2 had longer duration of analgesia than group 1 (13.06 vs 7.65 h). The blood pressure and cardiac rate were lower in group 2 (p<.05). Arterial saturation was similar. Group 2 had longer sedation. 17.3% of group 1 and 8.7% of group 2 had vomit (p = 0.03). Conclusions: Adding clonidine (2 µg/kg) to bupivacaine (0.25% 1.4 ml/kg) provided good post-surgical analgesia without significant haemodynamic changes. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of clonidine compared with oral midazolam in hypertensive patients undergoing cholecystectomy. Methods: A longitudinal prospective study was conducted with 120 patients admitted to the hospital «Guillermo Luis Fernández Hernández Baquero» at Holguín, Cuba, from January to May 2005. All patients underwent elective open cholecystectomy and they were classified as physical status II according to the American Society of Anaesthesiologists classification. Participants were divided into two groups. Group I (n = 60) was given 3 µg/kg-1 of clonidine; group II (n = 60) was given 0.5 mg/kg-1 of midazolam. Both drugs were given orally 90 minutes before induction. All participants were induced for general anaesthesia with vecuronium 0.1 mg/kg, then propofol 2 mg/kg-1 through endotracheal intubation. For the maintenance period the combination oxygen-nitrous oxide, continuous infusion of fentanyl, according to the patient's need, and infusion of vecuronium (1 ìg/kg-1/min-1) were given. Results: The level of sedation, heart rate and mean blood pressure (MBP) were monitored. At the unit of post-anaesthetic care, the MBP of group I was 82 ± 5.1 mgHg compared with the MBP of group II, which was 89 ± 9.2 mm Hg (p < 0.05). Conclusions: Clonidine shifted the haemodynamic variables towards lower values. The secondary effects in group I were, hypotension (22%), bradycardia (10%), dry mouth (18%) and sedation (93.3%); at group II, the secondary effects were hypotension (5%) and sedation (88.3%). [ABSTRACT FROM AUTHOR]