Document Detail


Clonidine premedication for coronary artery bypass grafting under high-dose alfentanil anesthesia: intraoperative and postoperative hemodynamic study.
MedLine Citation:
PMID:  8431573     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purpose of this study was to assess the efficacy of clonidine in achieving perioperative hemodynamic stability in patients undergoing coronary artery bypass grafting performed under high-dose alfentanil anesthesia. Twenty-four patients with left ventricular ejection fraction greater than 0.5 were prospectively studied in a double-blind manner; those requiring emergency procedures were excluded. They were randomized to receive either oral clonidine or placebo together with their premedication. Induction of anesthesia was achieved with 10 mg of alfentanil infused over 5 minutes followed by a continuous infusion of 60 mg/h during 1 hour, or until sternotomy, and then 30 mg/h until the end of surgery. Hemodynamic responses to noxious stimuli were treated with additional alfentanil boluses and isoflurane when these were unsuccessful. Intraoperative hemodynamic profile analyses showed a continuous increase in systemic vascular resistance and mean arterial pressure in the clonidine group from the time of skin incision until the onset of bypass, whereas the cardiac output profiles remained similar in the two groups. The number of additional alfentanil boluses was similar. Isoflurane requirements (1/11 v 4/13) were not significantly different, but only a few patients required this therapy. The postbypass hemodynamic profiles were similar. Severe hemodynamic impairment occurred in the clonidine group during warming in the postoperative period: this group showed a drop in systemic vascular resistance index (1276 +/- 347 v 1757 +/- 415 dyn.sec.cm-5.m2) that could not be compensated for by an increase in cardiac output despite normal filling pressures, causing hypotension (66 +/- 10 v 79 +/- 16 mmHg). This hemodynamic status led to greater requirements for vasoactive agents and inotropics in this group.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
F Abi-Jaoude; A Brusset; A Ceddaha; S Schlumberger; L Raffin; C Dubois; D Guilmet; M Fischler
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  7     ISSN:  1053-0770     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  1993 Feb 
Date Detail:
Created Date:  1993-03-16     Completed Date:  1993-03-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  35-40     Citation Subset:  IM    
Affiliation:
Centre Médico-Chirurgical FOCH, Université Paris Ouest, Suresnes, France.
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MeSH Terms
Descriptor/Qualifier:
Alfentanil / administration & dosage*
Anesthesia, Intravenous*
Blood Pressure / drug effects
Cardiac Output / drug effects
Clonidine / administration & dosage,  therapeutic use*
Coronary Artery Bypass*
Dobutamine / therapeutic use
Double-Blind Method
Female
Heart Rate / drug effects
Hemodynamics / drug effects
Humans
Hypotension / drug therapy
Male
Middle Aged
Monitoring, Intraoperative
Placebos
Postoperative Care
Preanesthetic Medication*
Pulmonary Wedge Pressure / drug effects
Time Factors
Vascular Resistance / drug effects
Chemical
Reg. No./Substance:
0/Placebos; 34368-04-2/Dobutamine; 4205-90-7/Clonidine; 71195-58-9/Alfentanil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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