Objectives: This prospective clinical trial aimed to investigate the eJJ(
xts oj oral clonidine pre-treatment on the total propojol requirements whilst ensuring equivalent depth oj anesthesia judged by continuous bispectral index (8IS) measurement.
Patients & Methods: The study comprised 40 jemales. assigned to abdominal hysterectomy jor benign uterine myoma, randomly allocated to 2 equal groups (n=20) clonidine or placebo group. Patients were premedicated 1 h bejore surgery with an oral dose ojeither clonidine 3/19/ leg or placebo. Anesthesia induced with propojol using a target-controlled injusion (TCl) pump with the target plasma concentration set to 4 J.lg/ml. The target value was raised by 1 pg/ml increments until a BIS level 45 was achieved and this was ta1cen as time zero (time-O) and the predicted plasma concentration was recorded. Anesthesia was maintained by TCI ojpropojol titrated to BIS oj45. Towards the end ojthe procedure the propojol injusion was adjusted to obtain BIS oj60 at the time oj application oj dressings (the Lime till 1 pg/ml predicted propojol injusion rate was achieved) and the time jrom end ojsurgery to eye opening and mean intraoperative BIS were recorded. At post-anesthetic recovery unit (PACU) recovery times were measured jrom completion oj wound dressing to obeying commands and to eligibility jor dischargefrom the recovery room using a modified Aldrete score oj:?9. Adverse hemodynamic events and total morphine requirements were recorded. Quality oj recovenJ (QoR) was measured using the QoR score. Predicted plasma propojol concentra tions were recorded jrom the TCl pump and arterial (actual) plasma pro[JoJbl cOllcpntmLLoFlS wer anoi!Jz('d with C1 [l[9fl-performance liqllid chromatography.
Results: The mean BlS recorded since start ofTel till time oj 1l1g/ml predicted injusion rate was signYlCantly (p=O.026) lower and the mean dose oj postoperative morphine was significantly less (pO.05) better in placebo compared to clonidine group. Actual plasma propojol concentrations at various time ojestimation showed a non-signifICant (p>O.05) difference between both groups, with an average concentration oj4.52±1.1 j.lg/ml in placebo and 4.42±O.95 I1g/ml in clonidine groups. On contrary, predicted plasma propojol concentration was significantly (p=O.034) less at time-O in clonidine group then the difference became non-significantly (p>O.05) less in clonidine compared to placebo group; with a signUicantly (p=O.04) less average predicted propojol concentration in clonidine versus placebo group. There was a positive progressively SignifICant correlation between actual and predicted plaSma propojol concentrations with time in placebo group, while such correlation in clonidine group was less Significant with advent ojoperative time.
Conclusion: It could be concluded that oral clonidine pre-medication had propojol sparing effect in patients receiving intravenous anesthesia using Tel associated with reduction oj postoperative analgesia requirement. |
