Thomson I R, Peterson M D, Hudson R J
Department of Anesthesia, University of Manitoba, Winnipeg, Canada.
Anesth Analg. 1998 Aug;87(2):292-9. doi: 10.1097/00000539-199808000-00010.
In this controlled study, we compared clonidine with conventional premedication in 35 patients undergoing coronary artery bypass grafting (CABG). After premedication with clonidine 5 microg/kg p.o. (Group C, n = 11), lorazepam 60 microg/kg p.o. (Group L, n = 13), or morphine 0.1 mg/kg plus scopolamine 6 microg/kg i.m. (Group M, n = 11), sedation, anxiety, and quality of premedication were graded. After the administration of sufentanil 2.0 microg/kg over 12.5 min, a computer-assisted infusion device targeted a sufentanil effect-site concentration of 0.75 ng/mL. Hemodynamic variables, end-tidal isoflurane concentration (ET-ISO), the electroencephalographic spectral edge, and the serum sufentanil concentration (SUF) were measured. There were no intergroup differences in anxiety, sedation, quality of premedication, the dose of sufentanil causing unconsciousness, or the electroencephalographic (EEG) response to induction. Intraoperative SUF was stable, with no intergroup difference. The average prebypass ET-ISO was lower in Group C than in Group M. The ET-ISO and peak ET-ISO after intense surgical stimulation were lower in Group C versus Groups L and M. Mean arterial blood pressure was lower in Group C versus Groups L and M. There were no intergroup differences in pharmacologic intervention, time to extubation, or intensive care unit stay. Clonidine produces sedation, anxiolysis, and quality of premedication comparable to conventional premedication. Compared with other drugs, clonidine does not alter the dose of sufentanil inducing unconsciousness or EEG slowing, but it uniquely reduces isoflurane requirements.
In patients undergoing coronary artery bypass grafting, clonidine produces sedation and relieves anxiety as effectively as conventional premedication. Clonidine does not uniquely alter the dose of sufentanil inducing unconsciousness or electroencephalographic slowing, but it significantly reduces isoflurane requirements.
在这项对照研究中，我们比较了可乐定与传统术前用药对35例接受冠状动脉旁路移植术（CABG）患者的影响。分别给予口服可乐定5μg/kg（C组，n = 11）、口服劳拉西泮60μg/kg（L组，n = 13）或肌肉注射吗啡0.1mg/kg加东莨菪碱6μg/kg（M组，n = 11）进行术前用药后，对镇静、焦虑及术前用药质量进行评分。在12.5分钟内静脉注射舒芬太尼2.0μg/kg后，通过计算机辅助输注装置将舒芬太尼效应室浓度目标设定为0.75ng/mL。测量血流动力学变量、呼气末异氟烷浓度（ET-ISO）、脑电图频谱边缘及血清舒芬太尼浓度（SUF）。在焦虑、镇静、术前用药质量、导致意识丧失的舒芬太尼剂量或诱导期脑电图（EEG）反应方面，各组间无差异。术中SUF稳定，组间无差异。C组体外循环前平均ET-ISO低于M组。与L组和M组相比，C组在强烈手术刺激后的ET-ISO及峰值ET-ISO更低。C组平均动脉血压低于L组和M组。在药物干预、拔管时间或重症监护病房停留时间方面，各组间无差异。可乐定产生的镇静、抗焦虑作用及术前用药质量与传统术前用药相当。与其他药物相比，可乐定不改变诱导意识丧失或EEG减慢的舒芬太尼剂量，但能独特地降低异氟烷需求量。
在接受冠状动脉旁路移植术的患者中，可乐定产生的镇静和缓解焦虑作用与传统术前用药同样有效。可乐定不会独特地改变诱导意识丧失或EEG减慢的舒芬太尼剂量，但能显著降低异氟烷需求量。
