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Comparative assessment of the effects of alfentanil, esmolol or clonidine when used as adjuvants during induction of general anaesthesia

Published online by Cambridge University Press:  23 December 2004

S. Fernandez-Galinski ,
S. Bermejo ,
R. Mansilla ,
O. Pol  and
M. M. Puig
S. Fernandez-Galinski
Affiliation:
Hospital Universitario del Mar, Department of Anaesthesiology, Universidad Autonoma de Barcelona, IMIM, Barcelona, Spain
S. Bermejo
Affiliation:
Hospital Universitario del Mar, Department of Anaesthesiology, Universidad Autonoma de Barcelona, IMIM, Barcelona, Spain
R. Mansilla
Affiliation:
Hospital Universitario del Mar, Department of Anaesthesiology, Universidad Autonoma de Barcelona, IMIM, Barcelona, Spain
O. Pol
Affiliation:
Hospital Universitario del Mar, Department of Anaesthesiology, Universidad Autonoma de Barcelona, IMIM, Barcelona, Spain
M. M. Puig
Affiliation:
Hospital Universitario del Mar, Department of Anaesthesiology, Universidad Autonoma de Barcelona, IMIM, Barcelona, Spain
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Abstract

Summary

Background and objective: This randomized, double-blinded, prospective study compared the effects of clonidine, esmolol or alfentanil on the level of hypnosis and haemodynamic responses to intravenous induction of anaesthesia and endotracheal intubation.

Methods: Forty-five patients scheduled for elective surgery were allotted to one of three groups. They were given either alfentanil 3 μg kg−1min−1 (n = 15); esmolol 1 mg kg−1min−1 (n = 16) or clonidine 3 μg kg−1 (n = 14) as a 10 min infusion. The infusions of alfentanil and esmolol, but not of clonidine, were maintained during endotracheal intubation. Anaesthesia was induced with midazolam (2 mg) and thiopental as required to suppress the eyelash reflex. Atracurium (0.5 mg kg−1) was given to produce neuromuscular block. Mean arterial pressure, heart rate, and bispectral index were recorded on arrival (baseline), after study drug infusion, after injecting midazolam and thiopental, as well as after endotracheal intubation. ANOVA and χ2-test were used for analysis.

Results: Blood pressure, heart rate and the bispectral index were unaltered by the study drugs, but thiopental requirements were reduced by alfentanil and clonidine (P < 0.014). Mean arterial pressure values (mean ± standard error of mean) in the alfentanil, esmolol and clonidine groups were: baseline: 107.8 ± 3.8; 106.6 ± 3.9; 103.4 ± 3.7 mmHg; after thiopental: 74.0 ± 4.2; 85.6 ± 4.3; 94.2 ± 4.1 mmHg and after endotracheal intubation: 91.7 ± 5.3; 114.1 ± 6.9; 123.6 ± 5.6 mmHg, respectively (two-way ANOVA, P < 0.001). Mean arterial pressure changed significantly after intubation from baseline (P < 0.001) after alfentanil (− 15%) and clonidine (+ 20%) but not after esmolol (+ 7%), while the changes between pre- and postintubation values were similar in all groups (24–33% increase). The bispectral index indicated that all patients had an adequate level of hypnosis, but the variability was higher in the esmolol group (P < 0.002).

Conclusions: None of the study drugs blocked the increase in mean arterial pressure induced by endotracheal intubation, but esmolol provided better overall haemodynamic stability. All groups had an adequate level of hypnosis.

Keywords

ANAESTHETICS, INTRAVENOUSANALGESICS, opioidsADRENERGIC ANTAGONISTS, adrenergic α-antagonists, adrenergic β-antagonistsCARDIOVASCULAR SYSTEMCENTRAL NERVOUS SYSTEM DEPRESSANTS, narcoticsHYPNOTICS AND SEDATIVES, non-barbiturateINTUBATION, intratracheal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 476 - 482
Copyright
2004 European Society of Anaesthesiology

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References

Bruder N, Ortega D, Granthil C. Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation. Ann Fr Anesth Reanim 1992; 11: 57–71.Google Scholar
Woods AW, Grant S, Harten J, Noble JS, Davidson JA. Tracheal intubating conditions after induction with propofol, remifentanil and lignocaine. Eur J Anaesthesiol 1998; 15: 714–718.Google Scholar
Fujii Y, Sayito Y, Takahashi S, Toyooka H. Diltiazem–lidocaine combination for the attenuation of cardiovascular responses to tracheal intubation in hypertensive patients. Can J Anaesth 1998; 45: 933–937.Google Scholar
Kissin I. General anesthetic action: an obsolete notion? Anesth Analg 1993; 76: 215–218.Google Scholar
Hall JE, Uhrich TD, Ebert TJ. Sedative, analgesic and cognitive effects of clonidine infusions in humans. Br J Anaesth 2001; 86: 5–11.Google Scholar
Zalunardo MP, Zollinger A, Spahn DR, et al. Effects of intravenous and oral clonidine on hemodynamic and plasma-catecholamine response due to endotracheal intubation. J Clin Anesth 1997; 92: 143–147.Google Scholar
Marinangeli F, Cocco C, Ciccozzi A, et al. Haemodynamic effects of intravenous clonidine on propofol or thiopental induction. Acta Anaesthesiol Scand 2000; 44: 150–156.Google Scholar
Johansen JW, Flaishon R, Sebel P. Esmolol reduces anesthetic requirement for skin incision during propofol/nitrous oxide/morphine anesthesia. Anesthesiology 1997; 86: 364–371.Google Scholar
Johansen JW, Schneider G, Windsor AM, Sebel PS. Esmolol potentiates reduction of minimum alveolar isoflurane concentration by alfentanil. Anesth Analg 1998; 87: 671–676.Google Scholar
Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia 1999; 54: 146–165.Google Scholar
Murdoch S, Cohen A. Intensive care sedation: a review of current British practice. Intensive Care Med 2000; 26: 922–928.Google Scholar
Talke PO, Lobo EP, Brown RB, Richardson CA. Clonidine-induced vasoconstriction in awake volunteers. Anesth Analg 2001; 93: 271–276.Google Scholar
Morgan JrGE, Mikhail MS. Non volatile anesthetic agents. In: Appleton and Lange, eds. Clinical Anesthesiology.Los Angeles, USA: Prentice Hall International, 1996: 128–148.
Fivush B, Neu A, Furth S. Acute hypertension crises in children: emergencies and urgencies. Curr Opin Pediatr 1997; 9: 233–236.Google Scholar
Zalunardo MP, Zollinger A, Szelloe P, Spahn DR, Seifert B, Pasch T. Stress response due to intubation. Clonidine versus esmolol. Anaesthesist 2001; 50: 21–25.Google Scholar
Davies DS, Wing AM, Reid JL, Neill DM, Tippett P, Dollery CT. Pharmacokinetics and concentration–effect relationships of intravenous and oral clonidine. Clin Pharmacol Ther 1977; 21: 593–601.Google Scholar
Metha D, Bradley JrEL, Kissin I. Effect of alfentanil on hypnotic and nociceptive components of thiopental sodium anaesthesia. J Clin Anesth 1991; 3: 280–284.Google Scholar
Higuchi H, Adachi Y, Dahan A, et al. The interaction between propofol and clonidine for loss consciousness. Anesth Analg 2002; 94: 886–891.Google Scholar
Iselin-Chaves IA, Flaishon R, Sebel P, et al. The effect of the interaction of propofol and alfentanil on recall, loss of consciousness and the bispectral index. Anesth Analg 1998; 87: 949–955.Google Scholar
Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg 2000; 90: 161–167.Google Scholar
Casati L, Fernández-Galinski S, Barrera E, Pol O, Puig MM. Isoflurane requirements during combined general-epidural anesthesia for major abdominal surgery. Anesth Analg 2002; 94: 1331–1337.Google Scholar