Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjan.2013.03.019
Brazilian Journal of Anesthesiology
Scientific Article

Administração de clonidina intravenosa e sua capacidade de reduzir a pressão da artéria pulmonar em pacientes submetidos a cirurgia cardíaca

Intravenous clonidine administration and its ability to reduce pulmonary arterial pressure in patients undergoing heart surgery

Benedito Barbosa João; José Luis Gomes do Amaral; Ronaldo Machado Bueno; David Ferez; Luiz Fernando dos Reis Falcão; Marcelo Vaz Perez; Itamar Souza de Oliveira-Júnior

http://dx.doi.org/10.1016/j.bjan.2013.03.019 Braz J Anesthesiol, vol.64, n1, p.40-48, 2014
PDF Português
PDF English
Downloads: 1
Views: 728

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 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.

Palavras-chave

Clonidina, Hipertensão pulmonar, Cirurgia cardíaca

Abstract

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

Keywords

Clonidine, Pulmonary hypertension, Heart surgery

References

Simonneau G, Galiè N, Rubin LJ. Clinical classification of pulmonary hypertension. J Am Coll Cardiol. ;43:12-5.

Voelkel NF, Quaife RA, Leinwand LA. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. ;24:1883-1891.

Rubenfire M, Bayram M, Hector-Word Z. Pulmonary hypertension in the critical care setting: classification, pathophysiology, diagnosis, and management. Crit Care Clin. ;23:801-834.

Levy JH. Management of systemic and pulmonary hypertension. Tex Heart Inst J. ;32:467-471.

Simonetti MPB, Valinetti EA, Ferreira FMC. Clonidine: from nasal descongestive to potent analgesic. Historical and pharmacological considerations. Rev Bras Anestesiol. ;47:47-37.

Alves TCA, Braz JRC, Vianna PTG. α2 agonistas em anestesiologia: aspectos clínicos e farmacológicos. Rev Bras Anestesiol. ;50:404-396.

Starke K, Gothert M, Kilbinger H. Modulation of neurotransmitter release by presynaptic autoreceptors. Physiol Rev. ;69:989-864.

Barnes PJ, Liu SF. Regulation of pulmonary vascular tone. Pharmacol Rev. ;47:131-87.

Blaise G, Langleben D, Hubert B. Pulmonary arterial hypertension: pathophysiology and anesthetic approach. Anesthesiology. ;99:1432-1415.

Rosner B. Fundamentals of biostatistics. :584.

Timm NH. Multivariate analysis with applications in educations and psychology. :687.

Schannwell CM, Steiner S, Strauer BE. Diagnostics in pulmonary hypertension. J Physiol Pharmacol. ;58:591-602.

McLaughlin VV, Archer SL, Badesch DB. ACCF/AHA 2009 expert consensus document on pulmonary hypertension. A report of the American College of Cardiology Foundation task force on expert consensus documents and the American Heart Association developed in collaboration with the American College of Chest Physicians. AmericanThoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation. ;119:2294-2250.

Diagnóstico, avaliaçcão e terapêutica da hipertensão pulmonar - Características estruturais, desenvolvimento normal e remodelamento patológico da circulacão pulmonar. Diretrizes da Sociedade Brasileira de Cardiologia. :1-20.

Kubo T, Misu Y. Pharmacological characterisation of the alpha adrenoceptors responsible for a decrease of blood pressure in the nucleus tractus solitarii of the rat. Naunyn-Schmiedeberg's Archives of Pharmacology. ;317:120-125.

Ruffolo RR. Distribution and function of peripheral alpha-adrenoceptors in the cardiovascular system. Pharmacol Biochem Behav. ;22:833-827.

Bogaz FA, Saroute AN, Tsutsui JM. Coronary spasm induced by dobutamine-atropine stress echocardiography. Arq Bras Cardiol. ;87:253-250.

Fattouch K, Sbraga F, Bianco G. Inhaled prostacyclin, nitric oxide, and nitroprusside in pulmonary hypertension after mitral valve replacement. Journal of Cardiac Surgery. ;20:176-171.

Amaral JLG, Ferreira ACP, Ferez D. Monitorizacão da respiraçcão: oximetria e capnografia. Rev Bras Anest. ;42:51-58.

Levy JH, Faraj BA, Zaidan JR. Effects of protamineon histamine release from human lung. Agents Actions. ;28:72-70.

Sauder RA, Hirshman CA. Protamine-induced histamine release in human skin mast cells. Anesthesiology. ;73:165-167.

Rent R, Ertel N, Eisenstein R. Complement activation by interaction of polyanions and polycations. I. Heparinprotamine induced consumption of complement. J Immunol. ;114:120-124.

Pritts CD, Pearl RG. Anesthesia for patients with pulmonary hypertension. Curr Opin Anaesthesiol. ;23:416-411.

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

Hirvonen J, Huttunen P, Nuutinen L. Catecholamines and free fatty acids in plasma of patients undergoing cardiac operations with hypothermia and bypass. J Clin Pathol. ;31:955-949.

Wallach R, Karp RB, Reves JG. Pathogenesis of paroxysmal hypertension developing during and after coronary bypass surgery: a study of hemodynamic and humoral factors. Am J Cardiol. ;46:559-565.

Souza MHL, Elias DO. Fundamentos da circulacão extracorpórea. ;V. 1:373-391.

Kulka PJ, Tryba M, Zenz M. Dose-response effects of intravenous clonidine on stress response during induction of anesthesia in coronary artery bypass graft patients. Anesth Analg. ;80:263-268.

Stocche RM, Garcia LV, Klamt JG. Comparison between sublingual nifedipine and intravenous clonidine to control perio-perative arterial hypertension in cataract procedures. Rev Bras Anestesiol. ;52:433-426.

Simoni RF, Cangiani LM, Pereira AM. Efficacy of intraoperative methadone and clonidine in pain control in the immediate postoperative period after the use of remifentanil. Rev Bras Anestesiol. ;59:421-430.

Ebert TJ, Hall JE, Barney JA. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. ;93:382-394.

Mizobe T, Maze M. Alpha 2-adrenoceptor agonists and anesthesia. Int Anesthesiol Clin. ;33:102-81.

Delaunay L, Bonnet F, Duvaldestin P. Clonidine decreases postoperative oxygen consumption in patients recovering from general anaesthesia. Br J Anaesth. ;67:397-401.

Kamibayashi T, Maze M. Clinical uses of alpha2 -adrenergic agonists. Anesthesiology. ;93:1349-1345.

5dcdc0ce0e8825fe20bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections