Efekt klonidinu na spotřebu desfluranu u celkové anestezie s monitorováním bispektrálního indexu

English version Czech version

: Nováček Martin ^1,2; Sanders Graeme ³
: Consultant Anaesthetist, Department of Anaesthesia and Intensive Care, Regional Hospital in Kolin, Kolin, Czech Republic ¹; Locum Consultant Anaesthetist, Department of Anaesthesia and Critical Care, Medway Maritime Hospital, Gillingham, Kent, United Kingdom ²; Consultant Anaesthetist, Department of Anaesthesia and Critical Care, Medway Maritime Hospital, Gillingham, Kent, United Kingdom ³
: Anest. intenziv. Med., 25, 2014, č. 6, s. 409-417
: Anaesthesiology - Original Paper

Cíl:
Cílem této randomizované, dvojitě slepé, placebem kontrolované studie je prokázat hypotézu, zda clonidin prohloubí anestezii, jejíž hloubka je měřená bispektrálním indexem, aby došlo ke snížení spotřeby desfluranu.

Typ studie:
Randomizovná, dvojitě slepá, placebem kontrolovaná studie.

Typ pracoviště:
Oddělení anesteziologie a intenzivní péče oblastní nemocnice.

Materiál a metoda:
50 pacientů (23 mužů a 27 žen), kteří podstoupili celkovou anestezii pro elektivní totální endoprotézu kyčle či kolene, bylo náhodně rozděleno do dvou skupin. Pacientům z první skupiny byl 10 minut před úvodem do anestezie aplikován intravenózně klonidin v dávce 2 μg . kg^-1, pacientům z druhé skupiny bylo podáno placebo. Hloubka anestezie byla udržována dle BIS s cílovou úrovní mezi 40 až 60. Po ukončení anestezie byla měřena spotřeba desfluranu. Po ukončení podávání desfluranu na konci operace byla měřena doba návratu vědomí. Pro statistické zpracování výsledků byl použit nepátový t-test.

Výsledky:
Celkem bylo zařazeno 25 pacientů s klonidinem a 25 pacientů s placebem. Spotřeba desfluranu byla signifikantně nižší ve skupině s klonidinem (33,1 ± 5,0 g) oproti skupině s placebem (44,5 ± 10,6 g (p < 0,001). Nebyl pozorován rozdíl v době návratu vědomí, který činil 6,4 ± 3,8 min ve skupině s klonidinem a 6,2 ± 3,7 min ve skupině s placebem (p = 0,822).

Závěr:
Intravenózně podaný clonidin snižuje spotřebu desfluranu během celkové anestezie. Tento šetřící efekt není spojen s prodloužením doby návratu vědomí.

Klíčová slova:
klonidin – desfluran – BIS – celková anestezie

Sources

1. Kamibayashi, T., Maze, M. Clinical uses of α2-adrenergic agonists. Anesthesiology., 2000, 93, p. 1345–1349.

2. Kulka, P. J., Tryba, M., Zenz, M. Dose-response effects of intravenous clonidine on stress response during induction of anesthesia in coronary artery bypass graft patients. Anesth. Analg., 1995, 80, p. 263–268.

3. Fehr, S. B., Zalunardo, M. P., Seifert, B. et al. Clonidine decreases propofol requirements during anaesthesia: effect on bispectral index. Br. J. Anaesth., 2001, 86, p. 627–632.

4. Morris, J., Acheson, M., Reeves, M., Myles, P. S. Effect of clonidine pre-medication on propofol requirements during lower extremity vascular surgery: a randomised controlled trial. Br. J. Anaesth., 2005, 95, p. 183–188.

5. Johansen, J. W., Sebel, P. S. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology., 2000, 93, p. 1336–1344.

6. El-Kerdawy, H. M. M., Van Zalingen, E. E., Bovill, J. G. The influence of α2-adrenoceptor agonist, clonidine, on the EEG and on the MAC of isoflurane. Eur. Journal Anaesthesiol., 2000, 17, p. 105–110.

7. Bloor, B. C., Flacke, W. E. Reduction in halothane anesthetic requirement by clonidine, an alpha-adrenergic agonist. Anesth. Analg., 1982, 61, p. 741–745.

8. De Deyne, C., Struys, M., Heylen, R. et al. Influence of intravenous clonidine pretreatment on anesthetic requirements during bispectral EEG-Guided sevoflurane anesthesia. J. Clin. Anaesth., 2000, 12, p. 52–57.

9. Rampil, I. J., King, B. S. Volatile anesthetics depress spinal motor neurons. Anesthesiology, 1996, 85, p. 129–134.

10. Song, D., Joshi, G. P., White, P. F. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology, 1997, 87, p. 3–10.

11. Goyagi, T., Tanaka, M., Nishikawa, T. Oral clonidine premedication reduces induction dose and prolongs awakening time from propofol-nitrous oxide anesthesia. Can. J. Anaesth., 1999, 46, p. 894–896.

12. Engelman, E., Lipszyc, M., Gilbart, E. et al. Effects of clonidine on anesthetic drug requirements and hemodynamic response during aortic surgery. Anesthesiology, 1989, 71, p. 178–187.

13. Flacke, J. W. Alpha2-adrenergic agonists in cardiovascular ane-sthesia. J. Cardiothor. and Vascular Anesth., 1992, 6, p. 344–359.

14. Ghignone, M., Quintin, L., Duke, P. C., Kehler, C. H., Calvillo, O.Effects of clonidine on narcotic requirements and hemodynamic responses during induction of fentanyl anesthesia and endotracheal intubation. Anesthesiology, 1986, 64, p. 36–42.

15. Orser, B. A. Depth-of-anesthesia monitor and the frequency of intraoperative awareness. N. E. J. Med., 2008, 358, p. 1189–1191.

16. Pandit, J. J., Cook, T. M., Jonker, W. R., O’Sullivan, E. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. Br. J. Anaesth., 2013, 110, p. 501–509.

17. Sandin, R. H., Enlund, G., Samuelsson, P., Lennmarken, C. Awareness during anaesthesia: a prospective case study. Lancet, 2000, 355, p. 707–711.

18. Sebel, P. S., Bowdle, T. A., Ghoneim, M. M. et al. The incidence of awareness during anesthesia: a multicenter United States study. Anesth. Analg., 2004, 99, p. 833–839.

19. Mashour, G. A., Shanks, A., Tremper, K. K. et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: randomised comparative effectiveness trial. Anesthesiology, 2012, 117, p. 717–725.

20. Leslie, K., Chan, M. T., Myles, P. S., Forbes, A., McCul-loch, T. J. Posttraumatic stress disorder in aware patients from the B-aware trial. Anesth. Analg., 2010, 110, p. 823–828.

21. Avidan, M. S., Zhang, L., Burnside, B. A. et al. Anesthesia awareness and the bispectral index. N. E. J. Med., 2008, 358, p. 1097–1108.

22. Avidan, M. S., Jacobsohn, E., Glick, D. et al. Prevention of intraoperative awareness in a high-risk surgical population. N. E. J. Med., 2011, 365, p. 591–600.

23. Altermatt, F. R., Bugedo, D. A., Delfino, A. E. et al. Evaluation of the effect of intravenous lidocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index. Br. J. Anaesth., 2012, 108, p. 979–983.

24. Hüpfl, M., Schmatzer, I., Buzath, A. et al. The effects of aminophylline on bispectral index during inhalational and total intravenous anaesthesia. Anaesthesia, 2008, 63, p. 583–587.

25. Başar, H., Ozcan, S., Buyukkocak, U., Akpinar, S., Apan, A. Effect of bispectral index monitoring on sevoflurane consumption. Eur. Journal Anaesthesiol, 2003, 20, p. 396–400.

26. Ibrahim, T. H., Yousef, G. T., Hasan, A. L. A., Elseduky, H. I. Effect of bispectral index monitoring on desflurane consumption and recovery time in morbidly obese patients undergoing laparoscipic sleeve gastrectomy. Anaesthesia Essays and Researches, 2013, 7, p. 89–93.

27. Moppett, I. Inhalational anaesthetics. Anaesth Intens Care Med., 2012, 13, p. 348–353.

28. Singaravelu, P., Barclay, P. Automated control of end-tidal inhalation anaesthetic concentration using GE Aisys Carestation. Br. J. Anaesth., 2013, 110, p. 561–566.

29. Jin-Kyoung, K., Duk-Kyung, K., Myeong-Jin Lee Relationship of bispectral index to minimum alveolar concentration during isoflurane, sevoflurane or desflurane anaesthesia. Journal of International Medical Research [online]. 2013 [cit.2013-23-12]. Dostupné na www: http://imr.sagepub.com/content/early/2013/12/23/0300060513505525

30. Kaur, A., Jain. A. K., Seghal, R., Sood, J., Hemodynamics and early recovery characteristic of desflurane versus sevoflurane in bariatric surgery. J. Anaesthesiol. Clin. Pharmacol., 2013, 29, p. 36–40.

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Article was published in

Anaesthesiology and Intensive Care Medicine

2014 Issue 6