Lauscher Patrick, Kertscho Harry, Krömker Malte, Haberichter Barbara, Zacharowski Kai, Rosenberger Peter, Meier Jens
Clinic of Anesthesiology and Intensive Care Medicine, Sana Klinikum Offenbach, Offenbach, Germany.
Division of Anaesthesiology, Balgrist University Hospital Zurich, Zurich, Switzerland.
BMC Anesthesiol. 2016 Oct 12;16(1):93. doi: 10.1186/s12871-016-0258-2.
Clonidine effectively decreases perioperative mortality by reducing sympathetic tone. However, application of clonidine might also restrict anaemia tolerance due to impairment of compensatory mechanisms. Therefore, the influence of clonidine induced, short-term sympathicolysis on anaemia tolerance was assessed in anaesthetized pigs. We measured the effect of clonidine on anaemia tolerance and of the potential for macrohemodynamic alterations to constrain the acute anaemia compensatory mechanisms.
After governmental approval, 14 anaesthetized pigs of either gender (Deutsche Landrasse, weight (mean ± SD) 24.1 ± 2.4 kg) were randomly assigned to intravenous saline or clonidine treatment (bolus: 20 μg · kg, continuous infusion: 15 μg · kg · h). Thereafter, the animals were hemodiluted by exchange of whole blood for 6 % hydroxyethyl starch (MW 130.000/0.4) until the individual critical haemoglobin concentration (Hb) was reached. Primary outcome parameters were Hb and the exchangeable blood volume (EBV) until Hb was reached.
Hb did not differ between both groups (values are median [interquartile range]: saline: 2.2 (2.0-2.5) g · dL vs. clonidine: 2.1 (2.1-2.4) g · dL; n.s.). Furthermore, there was no difference in exchangeable blood volume (EBV) between both groups (saline: 88 (76-106) mL · kg vs. clonidine: 92 (85-95) mL · kg; n.s.).
Anaemia tolerance was not affected by clonidine induced sympathicolysis. Consequently, perioperative clonidine administration probably has not to be omitted in view of acute anaemia.
可乐定通过降低交感神经张力有效降低围手术期死亡率。然而，可乐定的应用也可能由于代偿机制受损而限制贫血耐受性。因此，在麻醉猪中评估了可乐定诱导的短期交感神经阻滞对贫血耐受性的影响。我们测量了可乐定对贫血耐受性的影响以及宏观血流动力学改变限制急性贫血代偿机制的可能性。
经政府批准后，将14只麻醉的猪（德国长白猪，体重（均值±标准差）24.1±2.4 kg）随机分为静脉注射生理盐水或可乐定治疗组（推注：20 μg·kg，持续输注：15 μg·kg·h）。此后，通过用6%羟乙基淀粉（分子量130000/0.4）置换全血对动物进行血液稀释，直至达到个体临界血红蛋白浓度（Hb）。主要结局参数是直至达到Hb时的Hb和可交换血容量（EBV）。
两组之间的Hb无差异（数值为中位数[四分位间距]：生理盐水组：2.2（2.0 - 2.5）g·dL，可乐定组：2.1（2.1 - 2.4）g·dL；无显著性差异）。此外，两组之间的可交换血容量（EBV）也无差异（生理盐水组：88（76 - 106）mL·kg，可乐定组：92（85 - 95）mL·kg；无显著性差异）。
可乐定诱导的交感神经阻滞不影响贫血耐受性。因此，鉴于急性贫血，围手术期使用可乐定可能不必省略。
