Gaumann D M, Tassonyi E, Rivest R W, Fathi M, Reverdin A F
Department of Anesthesiology, University Hospital Geneva, Switzerland.
Can J Anaesth. 1991 Oct;38(7):837-43. doi: 10.1007/BF03036957.
The present study was conducted to examine the haemodynamic and endocrine effects of clonidine, given as sole preanaesthetic medication, in neurosurgical patients. Nineteen patients of ASA physical status I and II, subjected to craniotomy, randomly received po premedication of either clonidine (300 micrograms, n = 9) or placebo (n = 10). Blood pressure and heart rate were monitored continuously, while arterial blood samples were collected at specific times, from induction of anaesthesia to recovery, for the measurement of plasma concentrations of epinephrine, norepinephrine, cortisol, aldosterone, and glucose. Clonidine treatment led to a decrease in mean arterial blood pressure (MABP), heart rate (HR), and plasma cortisol and aldosterone concentrations throughout the study, compared with placebo (P less than 0.05). Clonidine, however, did not prevent increases in MABP (16 +/- 5 mmHg, mean +/- SE, P less than 0.05) and HR (18 +/- 4 bpm, P less than 0.05) during induction of anaesthesia, which was comparable to the placebo group. Plasma catecholamine concentrations did not differ between the two groups. Plasma glucose concentrations increased in both groups at the end of the study (P less than 0.05), but were lower in clonidine-treated patients (P less than 0.05). Though statistically significant, the observed inhibitory haemodynamic and endocrine effects of clonidine seem to be of minor clinical importance. As the action of clonidine on cerebral blood flow regulation is not well known, we see no advantage in the preanaesthetic administration of clonidine to neurosurgical patients with normal cardiovascular status.
本研究旨在探讨可乐定作为唯一麻醉前用药时，对神经外科手术患者的血流动力学和内分泌影响。19例美国麻醉医师协会（ASA）身体状况为I级和II级的患者接受开颅手术，随机接受口服可乐定（300微克，n = 9）或安慰剂（n = 10）进行麻醉前用药。连续监测血压和心率，同时在从麻醉诱导到恢复的特定时间采集动脉血样，以测定血浆肾上腺素、去甲肾上腺素、皮质醇、醛固酮和葡萄糖的浓度。与安慰剂组相比，在整个研究过程中，可乐定治疗导致平均动脉血压（MABP）、心率（HR）以及血浆皮质醇和醛固酮浓度降低（P < 0.05）。然而，可乐定并不能预防麻醉诱导期间MABP（16 ± 5 mmHg，均值 ± 标准误，P < 0.05）和HR（18 ± 4次/分钟，P < 0.05）的升高，这与安慰剂组相当。两组间血浆儿茶酚胺浓度无差异。研究结束时两组血浆葡萄糖浓度均升高（P < 0.05），但可乐定治疗的患者较低（P < 0.05）。尽管具有统计学意义，但观察到的可乐定对血流动力学和内分泌的抑制作用似乎临床意义不大。由于可乐定对脑血流调节的作用尚不清楚，我们认为对于心血管状态正常的神经外科手术患者，麻醉前给予可乐定并无益处。
