Abstract
Induction of anaesthesia is often associated with undesirable variations in blood pressure and heart rate. Clonidine has been demonstrated to attenuate many of these undesirable effects when used as a premedicant. Other alpha2 adrenergic agonists have been used to ameliorate the cardiostimulatory effects of ketamine in animals but there are few data on the use of this combination in humans. The effect of oral clonidine premedication, 5 μg · kg−1 on the haemodynamic changes induced by iv ketamine was studied in 42 patient volunteers. Ninety minutes before surgery, patients randomly received clonidine (C), diazepam (D), or a placebo (P) in a double-blinded fashion. Anaesthesia was induced with a ketamine infusion of I mg · kg−1· min−1 until loss of consciousness. Heart rate and phasic blood pressure were measured noninvasively prior to induction, before and up to seven minutes after tracheal intubation. There were no differences in demographics or baseline vital signs among the three groups. With ketamine administration, increases in heart rate and blood pressure were less in those patients given C preoperatively than in those who received either D or P. The peak increase in mean blood pressure was 39% (C) versus 70% (D) and 55% (P) (P < 0.01). Heart rate increased by a maximum of 20% (C) versus 41% (D) and 46% (P) (P < 0.01). We conclude that oral clonidine attenuates the hyperdynamic effects of anaesthetic induction with iv ketamine.
Résumé
L’induction de l’anesthésie s’accompagne souvent de changements indésirables de la tension artérielle et de la fréquence cardiaque. En prémédication, on a démontré que la clonidine diminuait ces effets défavorables. D’autres agonistes alpha2 ont été utilisés chez l’animal pour atténuer les effets cardiostimulateurs de la kétamine, mais nous ne possédons que peu de données sur l’utilisation de cette association chez l’humain. Les effets de la clonidine orale en prémédication à la posologie de 5 μg · kg−1 sur les changements hémodynamiques provoqués par la kétamine sont étudiés chez 42 patients volontaires. Quatre-vingt dix minutes avant la chirurgie, les patients recoivent au hasard et à double insu soit de la clonidine (C), du diazepam (D), ou un placébo (P). L’anesthésie est induite avec une perfusion de kétamine 1 mg · kg−1 min−1 jusqu’à la perte de conscience. La fréquence cardiaque et la tension artérielle sont mesurées de façon non invasive avant l’induction, avant l’intubation et jusqu’à sept minutes après celle-ci. On ne trouve pas de différences démographiques ou de paramètres vitaux initiaux entre les trois groupes. Avec l’administration de la kétamine, l’augmentation de fréquence cardique et de tension artérielle est moindre chez les patients qui ont reçu C en prémédication que ceux qui ont reçu D ou P. L’augmentation maximale de tension artérielle moyenne est de 39% (C) vs 70% (D) et 55% (P) (P < 0,01). Nous concluons que la clonidine orale atténue les effets hyperdynamiques de l’induction de l’anesthésie à la kétamine iv.
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Doak, G.J., Duke, P.C. Oral clonidine premedication attenuates the haemodynamic effects associated with ketamine anaesthetic induction in humans. Can J Anaesth 40, 612–618 (1993). https://doi.org/10.1007/BF03009697
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DOI: https://doi.org/10.1007/BF03009697