Clonidine postoperative

At present, no diugs exist that can selectively activate a2-receptor subtypes. Clonidine stimulates all three a2-subtypes with similar potency. Clonidine lowers blood pressure in patients with hypertension and it decreases sympathetic overactivity during opioid withdrawal. In intensive and postoperative care, clonidine is a potent sedative and analgesic and can prevent postoperative shivering. Clonidine and its derivative brimonidine lower... 

Dobrydnjov I, Axelsson K, Berggren L, et al Intrathecal and oral clonidine as prophylaxis for postoperative alcohol withdrawal syndrome a randomized double-blinded study. Anesth Analg 98 738—744, 2004... 

Clinical use The indications for levobupivacaine include wound infiltration (0.25 % solution), nerve conduction block (0.25 - 0.5 %), spinal analgesia (0.5 %) and epidural anesthesia (0.5 to 0.75 %). For labour analgesia, lower concentrations of levobupivacaine are recommended when administered as epidural injection (0.125 to 0.25 % up to 25 mg) or infusion (0.25 %). The maximum dose for ilioinguinal or iliohypogastric block in children is 1.25 mg/kg/side (0.25 to 0.5 % solutions). For postoperative pain management, levobupivacaine can be applied epidurally in combination with the opioids fentanyl or morphine or with the a2-agonist clonidine. 

Postoperative shivering following mild hypothermia has been associated with increased myocardial oxygen demand, which may lead to myocardial ischemia (48). It can also cause increased intracranial pressure (49). In addition, shivering may result in metabolic acidosis secondary to increased carbon dioxide production. Shivering can be minimized by careful rewarming of the patient before extubation and by using low-dose meperidine or clonidine. 

Sevoflurane often causes postoperative delirium and agitation in children, and this may be severe. The effect of intravenous clonidine 2 pg/kg on the incidence and severity of postoperative agitation has been assessed in a double-blind, randomized, placebo-controlled trial in 40 boys who had anesthetic induction with sevoflurane after oral midazolam premedication (32). There was agitation in 16 of those who received placebo and two of those who received clonidine the agitation was severe in six of those given placebo and none of those given clonidine. 

The effect of intravenous clonidine 2 micrograms/kg on the incidence and severity of postoperative agitation has been assessed in a double-blind, randomized, placebo-controlled trial in 40 boys who had anesthetic induction... 

The effects of intravenous and caudal epidural clonidine on the incidence and severity of postoperative agitation have been assessed in a randomized, double-blind study in 80 children, all of whom received sevoflurane as the sole general anesthetic for induction and maintenance... 

In patients with history of ocular inflammation, 1% prednisolone acetate, one drop four times a day for 3 to 7 days, can be prescribed prophylactically after Nd YAG. Rarely, a patient without history of inflammation may present with flare or mild cells in the anterior chamber or CME after capsulotomy. This also should be treated with topical steroids in the same manner. Post-YAG elevated lOP can often be prevented by treating the eye with apra-clonidine (lopidine) or other aqueous suppressant topical medication. The recommended dosage is one drop applied before the capsulotomy and one drop immediately after the procedure. Because of the potential risk of a retinal break, patients should receive dilated fundus examinations postoperatively as part of the routine follow-up within 1 to 4 weeks of capsulotomy, or sooner if symptoms develop. 

Effective postoperative pain relief can be obtained with a mixture of fentanyl and bupivacaine, which not only provides better analgesia than either drug alone, but also fewer adverse effects. There have been several studies of the efficacy of this mixture, using different doses and routes of administration, the addition of clonidine, and in comparison with morphine. 

A former preterm infant had two awake caudal anesthetics for herniotomy within 3 weeks (84). The first was uneventful with bupivacaine 0.25% at 35 weeks of age. At 38 weeks, the baby had intraoperative and postoperative bouts of apnea after inadvertent administration of bupivacaine 0.125% plus clonidine. 

Opioids potentiate the analgesic effect of neuraxial local anesthetics, with minimal adverse effects (SEDA-18,141) (SEDA-20, 121) (SEDA-22, 135), as shown in several studies with clonidine, fentanyl, morphine, or pethidine as the systemic or neuraxial analgesic, and bupivacaine, lidocaine, and ropivacaine as the local anesthetic. The benefits have been shown in relief of long-term pain and postoperative pain, in adults and children (SEDA-18, 141) (SEDA-18,146). 

The use of alcohol to treat patients in alcohol withdrawal or obstetrical patients with premature contractions is no longer recommended. Some medical centers continue to use alcohol to prevent or reduce the risk of alcohol withdrawal in postoperative patients, but administering a combination of a benzodiazepine with haloperidol or clonidine may be more appropriate. 

A study in 35 children undergoing ureteroneocystostomy found that the addition of clonidine 1 microgram/kg increased the duration of caudal block with bupivacaine 0.125% (with adrenaline (epinephrine) 1 400 000) and reduced the postoperative morphine requirements. A study in animals found that clonidine inereased the levels of bupivacaine and decreased its clearance. However, another study in children found that oral clonidine premedication reduced the plasma levels of lidocaine by 25 to 50%. Similar findings are reported in another study in which clonidine was given with epidural lidocaine. ... 

Owen MD, Fibuch EE, McQuillan R, et al. Postoperative analgesia using a low-dose, oral-transdermal clonidine combination lack of clinical efficacy. / Clin Anesth 1997 9(1) 8-14. 

Clonidine added to a continuous interscalene ropivacaine perineural infusion to improve postoperative analgesia a randomized, double-blind, controlled study. Anesth Ano/g 2005 100 1172-1178. 

Surgical acute pain although not FDA-approved, clonidine is a potent analgesic and has been used for postoperative pain control. Pre-operative administration provides anxiolysis and some sparing effect on anesthetics. This effect can translate into decreased postoperative pain and use of opioids. 

Treatment of adverse events for co-administration of clonidine with other agents, one or both doses should be reduced as necessary to avoid adverse events. Treatment of these adverse events is typically supportive, though it should be noted that intrathecal neostigmine appears to counteract clonidine-induced spinal hypotension and that yohimbine has been used to coimteract clonidine-induced sedation in postoperative patients. Hemodialysis is not likely to be effective for complications from neuraxial clonidine administration. 

Pharmacological premedication is usually prescribed for patients with planned overnight hospital stay. Low-dose benzodiazepines provide anxiolysis, light sedation and anterograde amnesia. Especially at advanced age, benzodiazepines may elicit paradoxical reactions or predispose to postoperative delirium. Alternatives for oral premedication are clonidin or haloperidol. Ambulatory patients usually do not receive preoperative sedatives. 

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