Journal of Nippon Medical School: Vol.71 No.1 page.044

Journal of Nippon Medical School

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ArticleTitle Oral Clonidine Premedication Exacerbates Hypotension Following Tourniquet Deflation by Inhibiting Noradrenaline Release

AuthorList Koichi Maruyama, Shinhiro Takeda, Takashi Hongo, Noriyuki Kobayashi, Chol Kim and Ryo Ogawa

Affiliation Department of Anesthesiology and Intensive Care, Nippon Medical School

Language EN

Volume 71

Issue 1

Year 2004

Page 44-50

Received August 7, 2003

Accepted September 18, 2003

Keywords catecholamine, clonidine, hypotension, premedication, tourniquet pain

Abstract Clonidine premedication prevents tourniquet pain and reduces sympathetic nerve activity. We evaluated hemodynamic changes and catecholamine release following tourniquet deflation during spinal anesthesia in patients who received oral clonidine premedication. The final analysis included 24 otherwise healthy patients undergoing lower-limb surgery randomly assigned to two groups: those receiving approximately 5 μg/kg of oral clonidine 1 hr before anesthesia (clonidine group, n=12), and those receiving no premedication (control group, n=12). After lumbar anesthesia, a tourniquet was applied for approximately 60 minutes to each patient. Electrocardiogram, arterial blood pressure, and consumption of butorphanol for tourniquet pain were monitored. Blood samples were obtained at different times to measure serum concentration of catecholamine. In the clonidine group, mean blood pressure decreased from 87±7 mmHg at baseline to 65±10 mmHg after tourniquet deflation (P<0.05). This peak reduction of mean blood pressure in the clonidine group was significantly lower than in the control group. After receiving clonidine premedication, the plasma noradrenaline concentrations in the clonidine group were significantly lower than those in the control group. Noradrenaline concentration increased in the control group from 162.3±89.2 pg/mL before tourniquet deflation to 199.3±95.7 pg/mL afterward (P<0.01), but there was no significant change in noradrenaline concentration after tourniquet deflation in the clonidine group. We conclude that oral clonidine premedication exacerbated the reduction in mean blood pressure following tourniquet deflation by inhibiting noradrenaline release.

Correspondence to Correspondence to Shinhiro Takeda, MD, Ph D, Department of Intensive Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
shinhiro@nms.ac.jp

ArticleTitle	Oral Clonidine Premedication Exacerbates Hypotension Following Tourniquet Deflation by Inhibiting Noradrenaline Release
AuthorList	Koichi Maruyama, Shinhiro Takeda, Takashi Hongo, Noriyuki Kobayashi, Chol Kim and Ryo Ogawa
Affiliation	Department of Anesthesiology and Intensive Care, Nippon Medical School
Language	EN
Volume	71
Issue	1
Year	2004
Page	44-50
Received	August 7, 2003
Accepted	September 18, 2003
Keywords	catecholamine, clonidine, hypotension, premedication, tourniquet pain
Abstract	Clonidine premedication prevents tourniquet pain and reduces sympathetic nerve activity. We evaluated hemodynamic changes and catecholamine release following tourniquet deflation during spinal anesthesia in patients who received oral clonidine premedication. The final analysis included 24 otherwise healthy patients undergoing lower-limb surgery randomly assigned to two groups: those receiving approximately 5 μg/kg of oral clonidine 1 hr before anesthesia (clonidine group, n=12), and those receiving no premedication (control group, n=12). After lumbar anesthesia, a tourniquet was applied for approximately 60 minutes to each patient. Electrocardiogram, arterial blood pressure, and consumption of butorphanol for tourniquet pain were monitored. Blood samples were obtained at different times to measure serum concentration of catecholamine. In the clonidine group, mean blood pressure decreased from 87±7 mmHg at baseline to 65±10 mmHg after tourniquet deflation (P<0.05). This peak reduction of mean blood pressure in the clonidine group was significantly lower than in the control group. After receiving clonidine premedication, the plasma noradrenaline concentrations in the clonidine group were significantly lower than those in the control group. Noradrenaline concentration increased in the control group from 162.3±89.2 pg/mL before tourniquet deflation to 199.3±95.7 pg/mL afterward (P<0.01), but there was no significant change in noradrenaline concentration after tourniquet deflation in the clonidine group. We conclude that oral clonidine premedication exacerbated the reduction in mean blood pressure following tourniquet deflation by inhibiting noradrenaline release.
Correspondence to	Correspondence to Shinhiro Takeda, MD, Ph D, Department of Intensive Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan shinhiro@nms.ac.jp