Abstract
Purpose
To investigate the influence of low dose clonidine premedication on perioperative glucose homeostasis.
Methods
Sixteen patients undergoing abdominal hysterectomy for benign uterine myoma were randomly assigned to receive eitheriv clonidine (1 μg·kg−1) 30 min before induction of general anesthesia (clonidine,n = 8) or saline (control,n = 8). Plasma concentrations of glucose, insulin, cortisol, epinephrine and norepinephrine were measured before, during and two hours after surgery. At the same time heart rate, mean arterial pressure and cardiac output were recorded.
Results
In both groups, glucose concentrations significantly increased during and after surgery. Intraoperative glucose plasma concentration in the clonidine group was higher than in the control group (clonidine: 6.8 ± 0.6 mmol·L−1 vs control: 5.7 ± 0.8 mmol·L−1,P < 0.05). This was accompanied by a lower insulin plasma concentration (clonidine: 3.9 ± 1.9 μU·mL−1 vs control: 6.5 ± 2.8 μU·mL−1,P < 0.05). Heart rate, mean arterial pressure and cardiac output remained unchanged throughout the study period without any differences between the groups. While norepinephrine plasma concentrations increased in the control group only (P < 0.05), the plasma concentrations of epinephrine and cortisol increased in both groups (P < 0.05). Clonidine significantly attenuated the cortisol response as reflected by lower intra- and postoperative cortisol plasma concentrations than in the control group (P < 0.05).
Conclusion
Premedication with clonidine 1 μg·kg−1 accentuates the hyperglycemic response to lower abdominal surgery caused by the decrease in insulin plasma concentrations.
Résumé
Objectif
Explorer l’influence d’une prémédication avec une faible dose de clonidine sur l’homéostase périopératoire du glucose.
Méthode
Seize patientes devant subir une hystérectomie abdominale pour un myome utérin bénin ont été réparties au hasard et ont reçu de la clonidine iv (1 μg·kg−1) 30 min avant l’induction de l’anesthésie générale (groupe clonidine,n = 8) ou une solution salée (groupe témoin,n = 8 ). Les concentrations plasmatiques de glucose, d’insuline, de cortisol, d’épinéphrine et de norépinéphrine ont été mesurées pendant l’intervention et deux heures après. Au même moment, la fréquence cardiaque, la tension artérielle moyenne et le débit cardiaque ont été enregistrés.
Résultats
Dans les deux groupes, les concentrations de glucose ont significativement augmenté pendant et après l’opération. La concentration plasmatique peropératoire dans le groupe clonidine a été plus élevée que celle du groupe témoin (clonidine : 6,8 ± 0,6 mmol·L−1 vs témoin : 5,7 ± 0,8 mmol·L−1,P < 0,05). Ce changement s’est accompagné d’une concentration plus faible d’insuline plasmatique (clonidine : 3,9 ± 1,9 μU·mL−1 vs témoin : 6,5 ± 2,8 μU·mL−1,P < 0,05). La fréquence cardiaque, la tension artérielle moyenne et le débit cardiaque sont demeurés inchangés tout au long de l’étude et ce, sans différence intergroupe. Les concentrations plasmatiques de norépinéphrine ont augmenté chez les témoins seulement (P < 0,05) alors que celles de l’épinéphrine et du cortisol ont augmenté dans les deux groupes (P < 0,05). La clonidine a diminué de façon significative la réponse du cortisol comme l’indiquent les concentrations plasmatiques peropératoires et postopératoires plus faibles que dans le groupe témoin (P < 0,05).
Conclusion
La prémédication avec 1 μg·kg−1 de clonidine augmente la réaction hyperglycémique à une hystérectomie abdominale causée par la baisse des concentrations plasmatiques d’insuline.
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References
Gaumann DM, Tssonyi E, Rivest RW, Fathi M, Reverdin AE. Cardiovascular and endocrine effects of clonidine premedication in neurosurgical patients. Can JAnaesth 1991; 38: 837–43.
Nishina K, Mikawa K, Maekawa N, Shiga M, Obara H. Effects of oral clonidine premedication on plasma glucose and lipid homeostasis associated with exogenous glucose infusion in children. Anesthesiology 1998; 88: 922–7.
Lyons FM, Bew S, Sheeran P, Hall GM. Effects of clonidine on the pituitary hormonal response to pelvic surgery. Br J Anaesth 1997; 78: 134–7.
Hirose H, Seto Y, Maruyama H, Dan K, Nakamura K, Saruta T. Effects of α2-adrenergic agonism, imidazolines, and G-protein on insulin secretion in β cells. Metabolism 1997; 46: 1146–9.
Dirks B, Vorwalter C, Grünen A, Ahnefeld FW. Basal plasma-catecholamine-level determination using HPLC-ED and different sample cleanup techniques. Chromatographia 1988; 25: 223–9.
Dorman T, Clarkson K, Rosenfeld BA, Shanholtz C, Lipsett PA, Breslow MJ. Effects of clonidine on prolonged postoperative sympathetic response. Crit Care Med 1997; 25: 1147–52.
Hayashi T, Maze M. Alpha2 adrenoceptor agonists and anaesthesia. Br J Anaesth 1993; 71: 108–18.
Quintin L, Roudot F, Roux C, et al. Effect of clonidine on the circulation and vasoactive hormones after aortic surgery. Br J Anaesth 1991; 66: 108–15.
Flache JW, Bloor BC, Flache WE, et al. Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology 1987; 67: 11–9.
Lowenthal DT, Matzek KM, MacGregor TR. Clinical pharmacokinetics of clonidine. Clin Pharmacokinet 1988; 14: 287–310.
Metz SA, Halter JB, Robertson RP. Induction of defective insulin secretion and impaired glucose tolerance by clonidine. Selective stimulation of metabolic alphaadrenergic pathways. Diabetes 1978; 27: 554–62.
DiTullio NW, Cieslinski L, Matthews WD, Storer B. Mechanisms involved in the hyperglycemic response induced by clonidine and other alpha-2 adrenoceptor agonists. J Pharmacol Exp Ther 1984; 228: 168–73.
Kim MH, Hahn TH. The effect of clonidine pretreatment on the perioperative proinflammatory cytokines, cortisol, and ACTH responses in patients undergoing total abdominal hysterectomy. Anesth Analg 2000; 90: 1441–4.
Crozier TA, Beck D, Schlaeger M, Wuttke W, Kettler D. Endocrinological changes following etomidate, midazolam, or methohexital for minor surgery. Anesthesiolgy 1987; 66: 628–35.
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Lattermann, R., Schricker, T., Georgieff, M. et al. Low dose clonidine premedication accentuates the hyperglycemic response to surgery. Can J Anesth 48, 755–759 (2001). https://doi.org/10.1007/BF03016690
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DOI: https://doi.org/10.1007/BF03016690