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Preoperative oral dextromethorphan vs. clonidine to prevent tourniquet-induced cardiovascular responses in orthopaedic patients under general anaesthesia

Published online by Cambridge University Press:  01 June 2007

A. Honarmand  and
MR. Safavi
A. Honarmand
Affiliation:
Isfahan University, School of Medicine, Department of Anesthesiology and Intensive Care, Isfahan, Iran
MR. Safavi*
Affiliation:
Isfahan University, School of Medicine, Department of Anesthesiology and Intensive Care, Isfahan, Iran
*
Correspondence to: Dr Mohammadreza Safavi, Department of Anesthesiology and Intensive Care Medicine, School of Medical Sciences, Isfahan University, Isfahan, Iran. E-mail: safavi@med.mui.ac.ir; Tel: +98 913 3152416; Fax: +98 311 7751182
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Summary

Background and objective

Preoperative oral dextromethorphan and intravenous clonidine attenuate arterial pressure and heart rate increases during tourniquet inflation under general anaesthesia. The effect of preoperative oral clonidine on these variables has not been investigated.

Methods

We designed this study to compare the effect of preoperative oral dextromethorphan or clonidine on haemodynamic changes during tourniquet inflation in 75 patients undergoing lower limb surgery under general anaesthesia. Patients were randomly assigned into three groups: dextromethorphan 30 mg (n = 25), clonidine 3 μg kg−1 (n = 25) and placebo (n = 25). Anaesthesia was maintained with isoflurane 1.2% and N2O 50% in oxygen with endotracheal intubation. Dextromethorphan, clonidine or placebo was given orally in a double-blinded fashion 90 min before induction of anaesthesia. Systolic, diastolic and mean arterial pressure and heart rate were measured at 0, 30, 45, 60 min after the start of tourniquet inflation, before tourniquet release and 20 min after tourniquet deflation.

Results

Systolic, diastolic and mean arterial pressure were significantly lower in the clonidine group compared with control after 45, 60 min tourniquet inflation and before tourniquet release (P < 0.05). Twenty minutes after deflation, diastolic and mean arterial pressure in the control group were still increased and significantly higher compared with the clonidine group (P < 0.05). Development of more than a 30% increase in systolic arterial pressure during tourniquet inflation was more frequent in the control group than in the other groups.

Conclusions

Preoperative oral clonidine 3 μg kg−1 significantly prevented tourniquet-induced systemic arterial pressure increase in patients under general anaesthesia better than oral dextromethorphan.

Keywords

CLONIDINEDEXTROMETHORPHANCARDIOVASCULAR PHYSIOLOGYANAESTHESIA GENERALTOURNIQUETSSURGERYLOWER LIMB
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 6 , June 2007 , pp. 511 - 515
Copyright
Copyright © European Society of Anaesthesiology 2006

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