Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000600005
Brazilian Journal of Anesthesiology
Scientific Article

Clonidina como medicação pré-anestésica em facectomias: comparação entre as doses de 100 µg e 200 µg

Clonidine as pre-anesthetic medication in cataract extration: comparison between 100 µg and 200 µg

José Roquennedy Souza Cruz; Denise Ferreira Barroso de Melo Cruz; Bruno Castelo Branco; Ana Ellen de Queiroz Santiago; José Luiz Gomes do Amaral

http://dx.doi.org/10.1590/S0034-70942009000600005 Braz J Anesthesiol, vol.59, n6, p.694-703, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: Avaliar a sedação, a pressão intraocular e as alterações hemodinâmicas com o uso de doses baixas de clonidina, 100 µg e 200 µg por via oral, como medicação pré-anestésica para operações de catarata em regime ambulatorial. MÉTODO: O trabalho foi realizado pela Universidade Federal de São Paulo, sendo um estudo clínico aleatório e duplamente encoberto em 60 pacientes, de ambos os sexos, estado físico ASA 1 e 2, com idade mínima de 18 anos e máxima de 80 anos. Os pacientes foram divididos em três grupos: placebo, clonidina 100 µg e 200 µg. As medidas de pressão intraocular, frequência cardíaca e pressão arterial, além da avaliação de sedação, foram feitas antes e após 90 minutos da administração da clonidina. Os níveis de sedação foram classificados de acordo com a escala de sedação de Ramsay. RESULTADOS: Pacientes que receberam placebo e 100 µg de clonidina não apresentaram redução da frequência cardíaca com diferença estatística significativa, enquanto os que receberam 200 µg de clonidina, sim. Os que receberam clonidina na dose de 200 µg apresentaram redução na pressão arterial sistólica e diastólica (p < 0,05). Um paciente que utilizou 200 µg de clonidina desenvolveu hipotensão arterial grave com pressão sistólica < 80 mmHg. Os pacientes tratados com clonidina apresentaram redução da pressão intraocular (p < 0,05). Quanto à sedação, 90 minutos após a administração de placebo e clonidina 100 µg e 200 µg por via oral, 25%, 60% e 80% dos pacientes encontravam-se, respectivamente, em Ramsay 3 ou 4. CONCLUSÕES: A dose de 100 µg de clonidina pode ser indicada como medicação pré-anestésica para facectomia, possuindo efeito na sedação, diminuição da pressão intraocular e ausência de efeitos adversos na pressão arterial sistêmica e frequência cardíaca.

Palavras-chave

CIRURGIA, oftálmica, COMPLICAÇÕES, MEDICAÇÃO PRÉ-ANÉSTÉSICA

Abstract

BACKGROUND AND OBJECTIVES: The objective of the present study was to evaluate the degree of sedation, intraocular pressure, and hemodynamic changes with premedication with low doses of oral clonidine, 100 µg and 200 µg, in outpatient cataract surgeries. METHODS: This is a randomized, double-blind, clinical study undertaken at the Universidade Federal de São Paulo with 60 patients of both genders, physical status ASA 1 and 2, ages 18 to 80 years. Patients were separated into three groups: placebo, clonidine 100 µg, and clonidine 200 µg. Intraocular pressure, heart rate, and blood pressure besides assessment of sedation were measured before and 90 minutes after the administration of clonidine. Sedation levels were classified according to the Ramsay sedation scale. RESULTS: Patients who received placebo and 100 µg of clonidine did not show reduction in heart rate, while a reduction in heart rate was observed in patients who received 200 µg of clonidine, and this difference was statistically significant. Patients who received 200 µg of clonidine also had a reduction in systolic and diastolic blood pressure (p < 0.05). One patient who received 200 µg of clonidine developed severe hypotension, with systolic pressure < 80 mmHg. Patients treated with clonidine had a reduction in intraocular pressure (p < 0.05). Ninety minutes after the oral administration of placebo and 100 µg and 200 µg of clonidine, 25%, 60%, and 80% of the patients respectively were classified as Ramsay 3 or 4. CONCLUSIONS: Clonidine 100 µg can be indicated as premedication for fasciectomies, being effective in sedation and reduction of intraocular pressure, without adverse effects on blood pressure and heart rate.

Keywords

COMPLICATIONS, PREMEDICATION, SURGERY, ophthalmologic

References

Nishina K, Mikawa K, Uesugi T. Efficacy of clonidine for prevention of perioperative myocardial ischemia: a critical appraisal and meta-analysis of the literature. Anesthesiology. 2002;96:323-329.

Escolano F, Castano J, Lopez R. Effects of omeprazole, ranitidine, famotidine and placebo on gastric secretion in patients undergoing elective surgery. Br J Anaesth. 1992;69:404-406.

Bauer KP, Dom PM, Ramirez AM. Preoperative intravenous midazolam: benefits beyond anxiolysis. J Clin Anesth. 2004;16:177-183.

Tarkkila P, Törn K, Tuominem M. Premedication with promethazine and transdermal scopolamine reduces the incidence of nausea and vomiting after intrathecal morphine. Acta Anaesthesiol Scand. 1995;39:983-986.

Taittonen M, Kirvela O, Aantaa R. Cardiovascular and metabolic responses to clonidine and midazolam premedication. Eur J Anaesthesiol. 1997;14:190-196.

Macario A, Weinger M, Truong P. Which clinical anesthesia outcomes are both common and important to avoid?: The perspective of a panel of expert anesthesiologists. Anesth Analg. 1999;88:1085-1091.

Kumar A, Bose S, Bhattacharya A. Oral clonidine pre-medication for elderly patients undergoing intraocular surgery. Acta Anaesthesiol Scand. 1992;36:159-164.

Filos KS, Patroni O, Goudas LC. A dose-response study of orally administered clonidine as premedication in the elderly: evaluating hemodynamic safety. Anesth Analg. 1993;77:1185-1192.

Scholz J, Tonner PH. Alpha2-Adrenoceptor agonists in anaesthesia: a new paradigm. Curr Opin Anaesthesiol. 2000;13:437-442.

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

Belhoula M, Ciébiéra JP, De La Chapelle A. Clonidine pre-medication improves metabolic control in type 2 diabetic patients during ophthalmic surgery. Br J Anaesth. 2003;90:434-439.

Lattermann R, Schricker T, Georgieff M. Low dose clonidine premedication accentuates the hyperglycemic response to surgery. Can J Anaesth. 2001;48:755-759.

Oddby-Muhrbeck E, Eksborg S, Bergendahl H. Effects of clonidine on postoperative nausea and vomiting in breast cancer surgery. Anesthesiology. 2002;96:1109-1114.

Kobayashi N, Ishii S. Effectiveness of clonidine in postoperative nausea and vomiting: epidural versus oral administration. Masui. 1997;46:538-542.

Zhao H, Ishiyama T, Oguchi T. Effects of clonidine and midazolam on postoperative shivering, nausea, and vomiting. Masui. 2005;54:1253-1257.

Stoche RM, Garcia LV, Klamt JG. Medição pré-anestésica com clonidina por via oral em cirurgia de catarata. Rev Bras Anestesiol. 2000;50:278-282.

Ghignone M, Noe C, Calvillo O. Anesthesia for ophthalmic surgery in the elderly: the effects of clonidine on intraocular pressure, perioperative hemodynamics, and anesthethic requirement. Anesthesiology. 1988;68:707-716.

Evidence Report/Technology Assessment: Number 16: Anesthesia Management during Cataract Surgery. .

Vann MA, Ogunnaike BO, Joshi GP. Sedation and anesthesia care for ophthalmologic surgery during local/regional anesthesia. Anesthesiology. 2007;107:502-508.

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

Hamilton RC, Gimbel HV, Strunin L. Regional anaesthesia for 12,000 cataract extraction and intraocular lens implantation procedures. Can J Anaesth. 1988;35:615-623.

Schein OD, Katz J, Bass EB. The value of routine preoperative medical testing before cataract surgery: Study of Medical Testing for Cataract Surgery. N Engl J Med. 2000;342:168-175.

Lermitte J, Chung F. Patient selection in ambulatory surgery. Curr Opin Anaesthesiol. 2005;18:598-602.

Golparvar M, Saghaei M, Sajedi P. Paradoxical reaction following intravenous midazolam premedication in pediatric patients: a randomized placebo controlled trial of ketamine for rapid tranquilization. Paediatr Anaesth. 2004;14:924-930.

Pawlik MT, Hansen E, Waldhauser D. Clonidine premedication in patients with sleep apnea syndrome: a randomized, double-blind, placebo-controlled study. Anesth Analg. 2005;101:1374-1380.

Wright PMC, Carabine UA, McClune S. Preanaesthethic medication with clonidine. B J Anaesth. 1990;65:628-632.

Hahm TS, Cho HS, Lee KH. Clonidine premedication prevents preoperative hypokalemia. J Clin Anesthesia. 2002;14:6-9.

Ferreira AA, Vicente JB, Queiroz Filho LS. Clonidina: medicação pré-operatória ideal para cirurgia oftálmica. Arq Inst Penido Burnier. 1990;32:7-10.

Greehalgh DL, Kumar CM. Sedation during ophthalmic surgery. Eur J Anaesthesiol. 2008;25:701-707.

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