Bernard J M, Lagarde D, Souron R
Départment d'Anesthésie-Réanimation Chirurgicale, Hôtel-Dieu, Nantes, France.
Anesth Analg. 1994 Dec;79(6):1126-32. doi: 10.1213/00000539-199412000-00018.
Agonist interactions in antinociceptive effects between clonidine and opioids can be used to reduce opioid requirements in surgical patients. However, clonidine can cause marked sedation and associated respiratory dysfunction. Thus, the benefit of using clonidine to reduce opioid use on respiration is questionable. This double-blind randomized study compared the analgesic efficacy, arterial blood gases, and pharmacokinetics of an intravenous (IV) infusion of fentanyl 75 micrograms/h and a mixture of fentanyl 25 micrograms/h plus clonidine 0.3 micrograms.kg-1.h-1 in 32 healthy young adults after surgery for scoliosis correction. Oxygen saturation (FIO2: 0.21) and respiratory rate were monitored as well as supplemental analgesia demands (IV ketoprofen via a patient-controlled device), pain, sedation, and hemodynamics. Oxygen and naloxone (5 micrograms.kg-1.min-1) were administered, respectively, if more than three episodes of oxygen saturation less than 90% were observed within 10 min and if PaCO2 was higher than 50 mm Hg. Pain relief, sedation, and ketoprofen requirements were similar in both groups. The number of episodes of arterial desaturation less than 90% (> 20 s) was 106 for four patients in the fentanyl group (versus none in the clonidine-fentanyl group). Naloxone was required in six patients and oxygen in two patients of the fentanyl group (versus none in the group receiving clonidine). Dopamine, 10 micrograms.kg-1.min-1, was required in one patient of the clonidine-fentanyl group to correct hypotension. Mean arterial blood pressure, plasma clearance, and the elimination rate constant of fentanyl were lower in the clonidine-fentanyl group than in the fentanyl group.(ABSTRACT TRUNCATED AT 250 WORDS)
可乐定与阿片类药物在镇痛作用中的激动剂相互作用可用于减少手术患者的阿片类药物需求量。然而，可乐定可引起明显的镇静作用及相关的呼吸功能障碍。因此，使用可乐定减少阿片类药物用量对呼吸的益处值得怀疑。这项双盲随机研究比较了32例接受脊柱侧弯矫正手术后的健康年轻成年人中，静脉输注75微克/小时芬太尼以及25微克/小时芬太尼加0.3微克·千克⁻¹·小时⁻¹可乐定混合物的镇痛效果、动脉血气和药代动力学。监测了氧饱和度（FIO₂：0.21）、呼吸频率以及补充镇痛需求（通过患者自控装置静脉注射酮洛芬）、疼痛、镇静和血流动力学。如果在10分钟内观察到超过3次氧饱和度低于90%，则分别给予氧气；如果动脉血二氧化碳分压高于50毫米汞柱，则给予纳洛酮（5微克·千克⁻¹·分钟⁻¹）。两组的疼痛缓解、镇静和酮洛芬需求量相似。芬太尼组有4例患者出现动脉血氧饱和度低于90%（>20秒）的发作次数为106次（可乐定-芬太尼组无）。芬太尼组有6例患者需要纳洛酮，2例患者需要氧气（接受可乐定的组无）。可乐定-芬太尼组有1例患者需要多巴胺（10微克·千克⁻¹·分钟⁻¹）来纠正低血压。可乐定-芬太尼组的平均动脉血压、芬太尼的血浆清除率和消除速率常数均低于芬太尼组。（摘要截断于250字）
