Document Detail


Clonidine produces a dose-dependent impairment of baroreflex-mediated thermoregulatory responses to positive end-expiratory pressure in anaesthetized humans.
MedLine Citation:
PMID:  15708868     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Perioperative hypothermia is common and results from anaesthesia-induced inhibition of thermoregulatory control. Hypothermia is blunted by baroreceptor unloading caused by positive end-expiratory pressure (PEEP), and is mediated by an increase in the vasoconstriction threshold. Premedication with clonidine impairs normal thermoregulatory control. We therefore determined the effect of clonidine on PEEP-induced hypothermia protection.
METHODS: Core temperature was evaluated in patients undergoing combined general and epidural anaesthesia for lower abdominal surgery. They were assigned to an end-expiratory pressure of zero (ZEEP) or 10 cm H(2)O PEEP. The PEEP group was divided into three blinded subgroups that received placebo (Cl-0), clonidine 150 microg (Cl-150) and clonidine 300 microg (Cl-300) respectively. Placebo or clonidine was given orally 30 min before surgery. We evaluated core temperature and thermoregulatory vasoconstriction. We also determined plasma epinephrine, norepinephrine, angiotensin II concentrations and plasma renin activity.
RESULTS: Core temperature after 180 min of anaesthesia was 35.1 (0.4) degrees C in the ZEEP group. PEEP significantly increased final core temperature to 35.8 (0.5) degrees C (Cl-0 group). Clonidine produced a linear, dose-dependent impairment of PEEP-induced hypothermia protection: final core temperatures were 35.4 (0.3) degrees C in the Cl-150 group and 35.0 (0.6) degrees C in the Cl-300 group. Similarly, clonidine produced a linear and dose-dependent reduction in vasoconstriction threshold: Cl-0, 36.4 (0.3) degrees C; Cl-150, 35.8 (0.3) degrees C; Cl-300, 35.4 (0.6) degrees C. Plasma norepinephrine, angiotensin II concentrations and renin activity were consistent with the thermoregulatory responses.
CONCLUSION: Baroreceptor unloading by PEEP normally moderates perioperative hypothermia. However, clonidine premedication produces a linear, dose-dependent reduction in this benefit.
Authors:
T Mizobe; Y Nakajima; M Sunaguchi; H Ueno; D I Sessler
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2005-02-11
Journal Detail:
Title:  British journal of anaesthesia     Volume:  94     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-03-10     Completed Date:  2005-04-26     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  536-41     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan. toshim@koto.kpu-m.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adrenergic alpha-Agonists / pharmacology*
Adult
Anesthesia, General
Angiotensin II / blood
Baroreflex / drug effects*
Body Temperature Regulation / drug effects*
Clonidine / pharmacology*
Dose-Response Relationship, Drug
Female
Hemodynamics / drug effects
Humans
Hypothermia / etiology,  physiopathology
Male
Middle Aged
Norepinephrine / blood
Positive-Pressure Respiration / adverse effects*
Premedication
Renin / blood
Vasoconstriction / drug effects
Grant Support
ID/Acronym/Agency:
GM 061655/GM/NIGMS NIH HHS; R01 GM061655-02/GM/NIGMS NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic alpha-Agonists; 11128-99-7/Angiotensin II; 4205-90-7/Clonidine; 51-41-2/Norepinephrine; EC 3.4.23.15/Renin
Comments/Corrections

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


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