Efficacy of Oral Clonidine as Premedication on Intraoperative Bleeding and Consumption of Inhalational Agent in Patients Undergoing Functional Endoscopic Sinus Surgery

Aim: To study the efficacy of oral clonidine on intraoperative bleeding and consumption of inhalational agent in patients undergoing FESS under general anesthesia. Study Design: Prospective, comparative observational study. Place and Duration of Study: Department of Anesthesiology, AVBRH, from June 2020 to May 2021. Methodology: A total of 30 patients fulfilling inclusion criteria scheduled for FESS were randomly allocated into 2 groups of 15 each; GROUP C (Clonidine group, n=15) who received tab clonidine 5 mcg/kg, 90 minutes before surgery and GROUP M (Multivitamin group, n=15) who received multivitamin tablet. Mean ± standard deviation (SD) or absolute values were used to indicate data; comparison of qualitative data were done using Chi-square test and Fisher’s exact test and quantitative variables using the student ‘t’ Test. P value < 0.05 was taken as statistically significant. Results: Bleeding was considerably less in the group C [1.65 ± 0.4] as compared to group M [2.20 ± 0.6] and is statistically significant [ P value = 0.006]. The mean MAC value (%) of sevoflurane consumption is lesser in the group C [1.25 ±0.25] than the group M [1.30 ±0.20] but not statistically significant (P value = 0.55). The mean dose (microgram) of fentanyl requirement was more in group M [ 120 ±20] than the group C [100 ± 25] and this was statistically significant (P value = 0.02). Conclusion: Oral Clonidine can be used as an excellent premedication and provides cost effective method to attain controlled hypotension as there is lesser requirement of costly inhalational agent and other analgesic drugs. Also, it maintains better hemodynamic stability with fewer side effects.

THE DIFFERENT TIMING OF ORAL CLONIDINE PREMEDICATION EFFECT ON SEDATION SCORE IN SPINE SURGERY

Background: Premedication is the administration of medication before anaesthesia. It is used to prepare the patient for anaesthesia and to provideoptimal conditions for surgery. Methods: The study of oral premedication dose of clonidine in spinal surgery at different time was conducted on sixty ASA grade-1 patients of eithersex between 20 to 60 years of age undergoing elective spine surgery. This study was performed after approval from ethics committee of the institute.Informed consent was obtained from each patient. Results: Sedation score was recorded preoperatively in both the groups when the patient were shifted to the operation theater according to score givenby American Society of Anaesthesia. In group-1, 25 patients (83.3%) had sedation score of 0 and 5 patients (16.7%) had score of 1. Similarly in group-2, 29 patients (96.7) had a sedation score 0 and only 1 patient (3.3%) had sedation score1. Conclusion: In conclusion this study establishes that the premedication with tab. clonidine 200µg (As tab. clonidine is available in 100µg) 90 minutebefore the surgery or 3.5 hour before the surgery produced adequate sedation Keywords: Clonidine, Sedation, Spine

THE DIFFERENT TIMING OF ORAL CLONIDINE PREMEDICATION EFFECT ON SEDATION SCORE IN SPINE SURGERY

Background: Premedication is the administration of medication before anaesthesia. It is used to prepare the patient for anaesthesia and to provideoptimal conditions for surgery. Methods: The study of oral premedication dose of clonidine in spinal surgery at different time was conducted on sixty ASA grade-1 patients of eithersex between 20 to 60 years of age undergoing elective spine surgery. This study was performed after approval from ethics committee of the institute.Informed consent was obtained from each patient. Results: The total induction dose of propofol required for the induction of the patient is 2-2.5 mg/kg body weight. In our study the average weightof the patient in group-1 was 58.83 kg and in group-2, average weight of the patient was 54.77 kg. The total average weight of patient in the study was 56.80 kg. Thus the total induction dose of propofol required should have been 117.66 mg in group-1, 109.54 mg in group-2 and 113.6 mg in averagetotal. Conclusion: In conclusion this study establishes that the premedication with tab. clonidine 200µg (As tab. clonidine is available in 100µg) 90 minutebefore the surgery or 3.5 hour before the surgery reduced induction dose of propofol. Keywords: Clonidine, Propofol, Spine

Compare the Effect of Oral Pregabalin versus Oral Clonidine for Attenuation of Hemodynamic Responses for Laryngoscopy and Tracheal Intubation

This study was done to assess the laryngoscopy and intubation responses of two drugs namely, Pregabalin 150mg and Clonidine 0.2mg. The drugs were orally administered 90 minutes prior to induction, as the peak action of both the drugs are known to be 1-2 hours after oral administration. Variation of heart rate changes decreases with increasing age. The selected age range was 18-60 years in our study.

Stability of clonidine hydrochloride in an oral powder form compounded for pediatric patients in Japan

Background Clonidine hydrochloride is used to treat sedative agent withdrawals, malignant hypertension, and anesthesia complications. Clonidine is also prescribed off-label to pediatric patients at a dose of 1 μg/kg. The commercially available enteral form of clonidine, Catapres® tablets, is often compounded into a powder form by pharmacists to achieve dosage adjustments for administration to pediatric patients. However, the stability and quality of compounded clonidine powder have not been verified. The objectives of this study were to formulate a 0.2 mg/g oral clonidine hydrochloride powder and assess the stability and physical properties of this compounded product in storage. Methods A 0.2 mg/g clonidine powder was prepared by adding lactose monohydrate to crushed and filtrated clonidine tablets. The powder was stored in polycarbonate amber bottles or coated paper packages laminated with cellophane and polyethylene. The stability of clonidine at 25 °C ± 2 °C and 60% ± 5% relative humidity was examined over a 120-d period in “bottle (closed),” “bottle (in use),” and “laminated paper” storage conditions. Drug dissolution and powder X-ray diffraction analysis were conducted to assess physicochemical stabilities. Validated liquid chromatography-diode array detection was used to detect and quantify clonidine and its degradation product, 2,6-dichloroaniline (2,6-DCA). Results Clonidine content was maintained between 90.0 and 110.0% of the initial contents in all packaging and storage conditions. After 120 d of storage, 2,6-DCA was not detected, and no crystallographic and dissolution changes were observed. Conclusions Compounded clonidine powder stability was maintained for 120 d at 25 °C ± 2 °C and 60% ± 5% relative humidity. This information may contribute to the management of clonidine compounded powder in community and hospital pharmacies in Japan.

A Comparative Study of Oral Atenolol and Oral Clonidine as Premedication for Hypotensive Anaesthesia in Patients Undergoing Functional Endoscopic Sinus Surgery under General Anaesthesia - A Randomized, Double Blinded Study in a Tertiary Care Hospital, Tirupati

BACKGROUND Bleeding during functional endoscopy sinus surgery (FESS) remains a main consideration. Even a small amount of blood may disturb the endoscopic view, increasing the likelihood of complications. So, we decided to compare the effects of clonidine and atenolol as oral premedication for hypotensive anaesthesia in patients undergoing FESS under general anaesthesia. The purpose of this study was to analyse and compare the efficacy of oral atenolol versus oral clonidine as premedication under general anaesthesia for induced hypotension in patients undergoing a functional endoscopic sinus surgery. METHODS The study included total 100 patients of age (18 – 60 years) [American Society of Anaesthesiologists (ASA grade I and II)] who were randomly divided into two groups of 50 each. Group - A (n = 50), a non-labelled clonidine tablet PO was given to the patients in the clonidine group in the dose of 2 mcg/kg at 7 pm the day before surgery and 4 mcg/kg two hours before surgery. Group - B (n = 50), a non-labelled atenolol 25 mg tablet was given PO to the patients in the atenolol group at 7 pm the day before surgery and also 2 hours before surgery. Induction and maintenance of general anaesthesia was performed by the same standard protocol for both groups. Hemodynamic effects [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), quality of surgical field, intraoperative complications, and post anaesthetic discharge score system (PADSS)] were recorded and statistically analysed. RESULTS The hemodynamic stability and good quality surgical field was obtained in both the groups. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. CONCLUSIONS We conclude that both oral clonidine and atenolol premedication provides superior and predictable perioperative hemodynamic control, reduces the requirement of hypotensive agents, and produces acceptable recovery characteristics. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. KEYWORDS Atenolol, Clonidine, Functional Endoscopic Sinus Surgery (FESS)

PROLONGED SYSTEMIC SPINAL ANESTHESIA IN ORTHOPEDICS AND TRAUMATOLOGY (clinical study)

Introduction. The task of providing anesthesia for long-term operations on the lower extremities in the traumatology and orthopedics is resolved by different ways. Prolonged systemic spinal anesthesia (SA) using oral clonidine (clophelin) deserves a special attention. Aim is to study the duration of SA using oral clonidine (clophelin) in orthopedic and traumatic patients who were undergoing prolonged surgery on the knee joint and the proximal tibia epi-metaphysis. Materials and Methods: The study involved 43 patients who were divided into two groups - group without clophelin (22 patients) and group with clophelin (21 patients) use. Operations in both groups were performed under conditions of SA (0.5% solution of isobaric bupivacaine at a dose of 13 mg in combination with 40 mg of 2% solution of lidocaine). In group with clophelin the premedication included the addition appointment of oral clophelin at a dose of 4 μg / kg (approximately 300 μg) 60 minutes before surgery. There were determined the SA duration, the total duration of intraoperative anesthesia, the total duration of the pneumatic harness action, a state of hemodynamics during the operation and postoperative period. Results and Discussions. There were no statistically significant differences in duration of operations in the group without clophelin and in group with clophelin that amounted to 228.63 ± 51.59 minutes and 241.04 ± 48.46 minutes, respectively (p = 0.24). SA duration in the group with clophelin statistically significantly exceeded the duration in group without clophelin and consisted of 236.38 ± 39.76 minutes and 204.77 ± 38.92 minutes, respectively (p = 0.011). The pulse rate in the clophelin group, comparing to the group without clophelin was significantly lower during the operation, in 6 hours after surgery and did not reach the level of critical bradycardia. The mean arterial pressure in the group with clophelin, comparing with group without clophelin was significantly lower during the operation, in 24 hours after surgery and did not reach the level of critical hypotension.Conclusions. The duration of SA by bupivacaine in combination with lidocaine using oral clonidine (clophelin) before surgery at a dose of 4 μg / kg (about 300 μg) in orthopedic and traumatic patients undergoing the knee joint surgery was increased by an average of 32 minutes. Against the background of prolonged systemic SA with the use of oral clonidine (clophelin), these operations can be performed for up to 4 hours. The detected hemodynamic changes against the background of clonidine use were not critical and are not considered as complications.