Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000100002
Brazilian Journal of Anesthesiology
Scientific Article

Níveis de sedação determinados pela clonidina e midazolam na medicação pré-anestésica: avaliação clínica e eletroencefalográfica bispectral

Sedation levels of oral preanesthetic clonidine and midazolam: clinical and electroencephalographic bispectral analysis

Leandro Gobbo Braz; Pedro Thadeu Galvão Vianna; José Reinaldo Cerqueira Braz; Maria Zoé Turchiari de Mello; Lídia Raquel de Carvalho

http://dx.doi.org/10.1590/S0034-70942002000100002 Braz J Anesthesiol, vol.52, n1, p.9-18, 2002
PDF Português
PDF English
Downloads: 0
Views: 869

Resumo

JUSTIFICATIVA E OBJETIVOS: Verificar o efeito sedativo da clonidina, um a2-agonista, e do midazolam, um benzodiazepínico, quando utilizados na medicação pré-anestésica, empregando-se avaliação clínica e eletroencefalográfica bispectral. MÉTODO: Após aprovação institucional e consentimento escrito fornecido, 45 pacientes de 18 a 65 anos, estado físico ASA I, foram aleatoriamente distribuídos nos grupos placebo (P), clonidina (C) ou midazolam (M), em que receberam, respectivamente placebo, 150 µg de clonidina ou 15 mg de midazolam por via oral, 60 minutos antes da indução da anestesia (n = 15 por grupo). A monitorização constituiu-se de eletrocardiograma (D II), pressão arterial não invasiva, freqüência cardíaca, saturação de pulso de oxigênio, freqüência respiratória, temperatura axilar e da sala de cirurgia e eletroencefalograma bispectral para determinação do índice bispectral (BIS). Esses atributos e a escala de sedações (1 - ansioso, 2 - calmo, 3 - sonolento, 4 - dormindo com reflexo, 5 - dormindo sem reflexo) foram obtidos aos 0 (M0), 15 (M15), 30 (M30), 40 (M40), 50 (M50) e 60 (M60) minutos após a medicação. RESULTADOS: Nos grupos não houve alteração significante dos parâmetros respiratórios, hemodinâmicos e de temperatura. Houve diferença significante entre os grupos na ES (M60: M=C>P) e no BIS (M50 e M60: M=C>P). CONCLUSÕES: Nas condições utilizadas, a clonidina e o midazolam determinaram níveis de sedação adequados e semelhantes na medicação pré-anestésica de pacientes estado físico ASA I, quando avaliados pela escala de sedação e pelo índice bispectral, sem determinarem alterações hemodinâmicas e respiratórias.

Palavras-chave

MEDICAÇÃO PRÉ-ANESTÉSICA, MEDICAÇÃO PRÉ-ANESTÉSICA, MONITORIZAÇÃO, MONITORIZAÇÃO, SEDAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: This study aimed at evaluating clonidine - an a2-agonist - and midazolam - a benzodiazepine - sedative effects in preanesthetic medication by clinical and electroencephalographic analysis. METHODS: After institutional approval and their informed written consent, participated in this study 45 patients aged 18 to 65 years, physical status ASA I, who were randomly distributed in placebo (P), clonidine (C) or midazolam (M) groups. Patients were premedicated with oral placebo, 150 µg clonidine or 15 mg midazolam 60 minutes before anesthetic induction (n = 15 per group). Monitoring consisted of electrocardiogram (D II), non-invasive blood pressure, heart rate, oxygen saturation, respiratory rate, axillary and operating room temperature and bispectral electroencephalography to determine bispectral index (BIS). These attributes and sedation scale (1-anxious, 2-calm, 3-sleepy, 4-sleeping with reflex, 5-sleeping without reflex) were obtained at 0 (M0), 15 (M15), 30 (M30), 40 (M40), 50 (M50) and 60 (M60) minutes after medication. RESULTS: There were no significant differences in respiratory, hemodynamic and temperature parameters. There has been a significant difference among groups in sedation scale (M60: M=C>P) and BIS (M50 and M60: M=C>P). CONCLUSIONS: In our conditions, clonidine and midazolam have determined similar sedation levels in patients ASA I when evaluated by sedation scale and BIS. No hemodynamic and respiratory changes were observed with both drugs.

Keywords

MONITORING, MONITORING, PREANESTHETIC MEDICATION, PREANESTHETIC MEDICATION, SEDATION

References

Alves TCA, Braz JRC, Vianna PTG. a2-Agonistas em anestesiologia: aspectos clínicos e farmacológicos. Rev Bras Anestesiol. 2000;50:396-404.

Doze VA, Chen B-X, Maze M. Dexmedetomidine produces a hypnotic-anesthetic action in rats via activation of central a2-adrenoceptors. Anesthesiology. 1989;71:75-79.

Mastrianni JA, Abbott FV, Kunos G. Activation of central mµ-opioid receptors is involved in clonidine analgesia in rats. Brain Res. 1989;479:283-289.

Deckert V, Lachaud V, Parini A. Contribution of alpha 2-adrenoceptors to the central cardiovascular effects of clonidine and S 8350 in anaesthetized rats. Clin Exp Pharm Physiol. 1991;18:401-408.

Goyagi T, Nishikawa T. Oral clonidine premedication enhances the quality of postoperative analgesia by intrathecal morphine. Anesth Analg. 1996;82:1192-1196.

Park J, Forrest J, Kolesar R. Oral clonidine reduces postoperative PCA morphine requirements. Anesth Analg. 1996;82:1192-1196.

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

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

Hoffman BB, Lefkowitz RJ. Cathecolamines and Sympathomimetic Drugs and Adrenergic Receptor Antagonists. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 1996:199-248.

Maze M, Buttermann AE, Kamibayashi T. Alpha-2 Adrenergic Agonists, em: White PF - Textbook of Intravenous Anesthesia. 1997:433-445.

Lowenthal DT, Matzek KM, Macgregor TR. Clinical pharmacokinetics of clonidine. Clin Pharmacokinet. 1988;14:287-310.

Lonnqvist PA, Bergendahl HTG, Eksborg S. Pharmacokinetics of clonidine after rectal administration in children. Anesthesio- logy. 1994;81:1097-1101.

Hargreaves J. Benzodiazepine premedication in minor day-case surgery: comparison of oral midazolam and temazepam with placebo. Br J Anaesth. 1988;61:611-616.

Shafer A, White PF, Urquhart ML. Outpatient premedication: use of midazolam and opioid analgesics. Anesthesiology. 1989;71:495-501.

Ramsay MAE, Savege TM, Simpson BRJ. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-659.

Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology. 1998;89:980-1002.

Kissin I. Depth of anesthesia and bispectral index monitoring. Anesth Analg. 2000;90:14-17.

Sebel PS. Neurophisiological monitoring awareness and outcomes in cardiac surgery. Sem Cardioth Vasc Anesth. 2000;4:49-52.

Schulte-Tamburen AM, Scheier J, Briegel J. Comparison of five sedation scoring systems by means of auditory evoked potentials. Intensive Care Med. 1999;25:377-382.

Sunzel M, Paalzow L, Berggen L. Respiratory depression by midazolam and diazepam. Anesthesiology. 1980;53:494.

Ezri T, Szmunk P, Shklar B. Oral clonidine premedication does not prolong analgesia after herniorrhaphy under subarachnoid anesthesia. J Clin Anesth. 1998;10:474 -481.

Hieble JP, Rufolo Jr RR. Imidazoline receptors: historical perspective. Fundam Clin Pharmacol. 1992;6:7-13.

Li G, Regunathan S, Barrow CJ. Agmatine is endogenous clonidine-displacing substance in brain. Science. 1994;263:966-969.

Reis DJ, Ruggiero DA, Morrison SF. The C1 area of the rostro-ventrolateral medulla oblongata: A critical brainstem region for control of resting and reflex integration of arterial pressure. Am J Hypertens. 1989;2:368-374.

Reis DJ, Regunathan S, Meeley MP. Imidazole receptors and clonidine-displacing substance in relationship to control of blood pressure, neuroprotection and adrenomedullary secretion. Am J Hypertens. 1992;5:51-57.

Vanthuyne S, De Deune C, Struys M. BIS-monitoring of the sedative effects of IV clonidine in awake patients. J Neurosurg Anesthesiol. 2000;12:177.

Correa-Sales C, Nacif-Coelho C, Reid K. Inhibition of adenyl cyclase in the locus coeruleus mediates the hypnotic response to an alpha 2 agonist in the rat. J Pharmacol Exp Ther. 1992;263:1046-1049.

Correa-Sales C, Rabin B, Maze M. A hypnotic response to dexmedetomidine, a a2-agonist, is mediated in the locus coeruleus in rats. Anesthesiology. 1992;76:948-952.

Correa-Sales C, Reid K, Maze M. Pertussis toxin mediated ribosylation of G proteins blocks the hypnotic response to an a2-agonist in the locus coeruleus of the rat. Pharmacol Biochem Behav. 1992;43:723-727.

Soderpalm B, Engel JA. Biphasic effects of clonidine on conflict behavior: involvement of different alpha-adrenoceptors. Pharmacol Biochem Behav. 1988;30:471-477.

Naguib M, Yaksh TL. Antinoceptive effects of spinal cholinesterase inhibition and isobalographic analysis of the interaction with µ and a2 receptor systems. Anesthesiology. 1994;80:1338-1348.

Thogersen B, Ording H. Bispectral index monitoring: comparation of two types of electrode. Anaesthesia. 2000;55:242-246.

5dd6d22d0e8825e16e13f286 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