Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery
Background: The antihypertensive drug, clonidine, is a centrally acting alpha 2 agonist, useful as a premedication because of its sedative and analgesic properties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endos...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2005-01-01
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| Series: | Journal of Research in Medical Sciences |
| Online Access: | http://journals.mui.ac.ir/jrms/article/view/391 |
| _version_ | 1811246838930472960 |
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| author | M Jabalameli SM Hashemi HA Soltani SJ Hashemi |
| author_facet | M Jabalameli SM Hashemi HA Soltani SJ Hashemi |
| author_sort | M Jabalameli |
| collection | DOAJ |
| description | Background: The antihypertensive drug, clonidine, is a centrally acting alpha 2 agonist, useful as a premedication because of its sedative and analgesic properties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endoscopic sinus surgery. We also evaluated the relation between bleeding volume and consumption of fentanyl and hydralazine to control hypotension. Methods: This prospective double - blinded clinical trial was performed on 113 patients (ASA I, ASA II). Fifty-two patients received oral clonidine (5 µg/kg) while the other 61 patients received placebo. During general anesthesia, the hemodynamic endpoint of the anesthetic management was maintenance of hypotension (MAP) at 70 mmHg for producing a bloodless surgical field. The direct control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol % as needed. When it was unsuccessful, an intravenous fentanyl bolus of 2 µg/kg was also added. When both drugs failed, hydralazine , was given intravenously as a bolus and intermittently, 0.1mg/kg up to a maximum dose of 40 mg. Intraoperative bleeding was assessed on a six – point scale from 0 (= no bleeding) to 5 (= severe bleeding). Data were compared with chisquare test, fisher's exact test and Student t-test. Results: There was less bleeding volume in the clonidine group (mean ± SD) than in the placebo group (144 ± 75 Vs 225 ± 72 ml, P<0.05). Frequency of bleeding severity scores 3 and 4 (troublesome with repeated suction) were lower in the clonidine group than in the placebo group (12% Vs 35%, P< 0.05). Fentanyl requirement was significantly lower (112 ± 18 Vs 142 ± 21 µg, P < 0.05) in the clonidine group. Hydralazine requirement was significantly lower (0.45 ± 1.68 Vs 2.67 ± 4.33 Conclusion: Premedication with oral clonidine reduces bleeding in endoscopic sinus surgery and also decreases fentanyl, and hydralazine consumption for controlling hypotension. Keywords: Sinus surgery, Endoscopy, Clonidine, Hydralazine, Fentanyl, Bleeding |
| first_indexed | 2024-04-12T14:59:11Z |
| format | Article |
| id | doaj.art-b6d97519c913418eacbeea390b0a767e |
| institution | Directory Open Access Journal |
| issn | 1735-1995 1735-7136 |
| language | English |
| last_indexed | 2024-04-12T14:59:11Z |
| publishDate | 2005-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Research in Medical Sciences |
| spelling | doaj.art-b6d97519c913418eacbeea390b0a767e2022-12-22T03:28:07ZengWolters Kluwer Medknow PublicationsJournal of Research in Medical Sciences1735-19951735-71362005-01-011012530Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus SurgeryM JabalameliSM HashemiHA SoltaniSJ HashemiBackground: The antihypertensive drug, clonidine, is a centrally acting alpha 2 agonist, useful as a premedication because of its sedative and analgesic properties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endoscopic sinus surgery. We also evaluated the relation between bleeding volume and consumption of fentanyl and hydralazine to control hypotension. Methods: This prospective double - blinded clinical trial was performed on 113 patients (ASA I, ASA II). Fifty-two patients received oral clonidine (5 µg/kg) while the other 61 patients received placebo. During general anesthesia, the hemodynamic endpoint of the anesthetic management was maintenance of hypotension (MAP) at 70 mmHg for producing a bloodless surgical field. The direct control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol % as needed. When it was unsuccessful, an intravenous fentanyl bolus of 2 µg/kg was also added. When both drugs failed, hydralazine , was given intravenously as a bolus and intermittently, 0.1mg/kg up to a maximum dose of 40 mg. Intraoperative bleeding was assessed on a six – point scale from 0 (= no bleeding) to 5 (= severe bleeding). Data were compared with chisquare test, fisher's exact test and Student t-test. Results: There was less bleeding volume in the clonidine group (mean ± SD) than in the placebo group (144 ± 75 Vs 225 ± 72 ml, P<0.05). Frequency of bleeding severity scores 3 and 4 (troublesome with repeated suction) were lower in the clonidine group than in the placebo group (12% Vs 35%, P< 0.05). Fentanyl requirement was significantly lower (112 ± 18 Vs 142 ± 21 µg, P < 0.05) in the clonidine group. Hydralazine requirement was significantly lower (0.45 ± 1.68 Vs 2.67 ± 4.33 Conclusion: Premedication with oral clonidine reduces bleeding in endoscopic sinus surgery and also decreases fentanyl, and hydralazine consumption for controlling hypotension. Keywords: Sinus surgery, Endoscopy, Clonidine, Hydralazine, Fentanyl, Bleedinghttp://journals.mui.ac.ir/jrms/article/view/391 |
| spellingShingle | M Jabalameli SM Hashemi HA Soltani SJ Hashemi Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery Journal of Research in Medical Sciences |
| title | Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery |
| title_full | Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery |
| title_fullStr | Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery |
| title_full_unstemmed | Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery |
| title_short | Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery |
| title_sort | oral clonidine premedication decreases intraoperative bleeding in patients undergoing endoscopic sinus surgery |
| url | http://journals.mui.ac.ir/jrms/article/view/391 |
| work_keys_str_mv | AT mjabalameli oralclonidinepremedicationdecreasesintraoperativebleedinginpatientsundergoingendoscopicsinussurgery AT smhashemi oralclonidinepremedicationdecreasesintraoperativebleedinginpatientsundergoingendoscopicsinussurgery AT hasoltani oralclonidinepremedicationdecreasesintraoperativebleedinginpatientsundergoingendoscopicsinussurgery AT sjhashemi oralclonidinepremedicationdecreasesintraoperativebleedinginpatientsundergoingendoscopicsinussurgery |