Premedication with Oral and Transdermal Clonidine Provides Safe and Efficacious Postoperative Sympatholysis
Anesthesia and Analgesia
We studied 61 patients undergoing elective major noncardiac surgery in a randomized, double-blind, placebo-control clinical trial to test the hypothesis that the addition of clonidine to a standardized general anesthetic could safely provide postoperative sympatholysis for patients with known or suspected coronary artery disease. Patients were allocated randomly to receive either placebo (n = 31) or clonidine (n = 30). The treatment group received prernedication with a transdermal clonidine
... ermal clonidine system (0.2 mg/d) the night prior to surgery, which was left in place for 72 h, and 0.3 mg oral clonidine 60-90 min before surgery. Clonidine reduced enflurane requirements, intraoperative tachycardia, and myocardial ischemia (1/28 clonidine patients vs 5/24 placebo, P = 0.05). However, clonidine decreased heart rates only during the first five postoperative hours; the incidence of postoperative myocardial ubstantial morbidity, mortality, and costs are associated with coronary artery disease (CAD) in S elderly surgical patients, particularly in those who have vascular surgery (1 ). Electrocardiogram (ECG) monitoring has been used to document that patients with CAD are more likely to manifest myocardial ischemia after surgery rather than before surgery (2). Clonidine is an a,-adrenergic agonist with the potential to improve outcome in high-risk patients undergoing noncardiac surgery (3,4).