Abstract
Since clonidine, an α2-agonist, inhibits the release of norepinephrine or acetylcholine which can decrease nondepolarizing muscle relaxant-induced neuromuscular blockade, the authors examined whether clonidine given as an oral preanaesthetic medication would alter the onset, duration or recovery of a vecuronium neuromuscular blockade in lightly anaesthetized patients. Thirty-eight patients (aged 20–73 yr) randomly received oral clonidine either approximately 5 μg · kg−1 (n = 21) or none (n = 17), 90 min before arrival in the operating room. We measured acceleration of thumb contraction with ulnar nerve stimulation at the wrist to assess neuromuscular blockade. The onset time (the time from injection to decrease to 5% of baseline twitch height), duration (the time interval between injection and return of the first twitch to 25% of the baseline value), and recovery index (the time interval of the first twitch from 25% to 75% of the baseline value) of neuromuscular blockade from a single bolus of vecuronium 0.1 mg · kg−1 iv were determined and compared between the clonidine-treated and control patients during lower abdominal or extremity surgery under epidural plus general anaesthesia with fentanyl and nitrous oxide in oxygen. No differences were noted between the control and clonidine groups in onset time (100 ± 6 sec (mean ± SE) vs 101 ± 6 sec), duration (44.5 ±2.7 min vs 42.9 ±2.7 min), or recovery index (21.6 ± 2.8 min vs 19.1 ± 1.9 min) of neuromuscular blockade from vecuronium, respectively. These results show that oral preanaesthetic medication of clonidine 5 μg · kg−1 does not alter neuromuscular blockade induced with vecuronium 0.1 mg · kg−1 in patients during combined epidural and fentanyl/nitrous oxide general anaesthesia.
Résumé
La clonidine, un α2-agoniste, inhibe la libération de norépinéphrine et de l’acétylcholine; elle peut donc diminuer la curarisation induite par un myorelaxant non dépolarisant. Nous nous sommes demandés si la clonidine administrée en prémédication pouvait altéter l’installation, la durée et la récupération de la curarisation produites par le vécuronium chez dez patients maintenus sous anesthése légère. Trente-huit patients (âgés de 20 à 73 ans) sont choisis au hasard pour recevoir soit de la clonidine orale à la dose approximative de 5 μg · kg−1 (n = 21) soit un placebo (n = 17), 90 min avant leur transfert en salle d’opération. Pour évaluer la curarisation, nous mesurons au niveau du poignet, l’accélération de la contraction du pouce en stimulant le nerf cubital. L’installaion (l’intervalle entre l’injection à la diminution à 5% de la ligne de basse de la hauteur du twitch) et l’indice de récupération (l’intervalle requis pour le retour du premier twitch de 25 à 75% de sa valeur initiale) du bloc neuromusculaire sont déterminés après l’administration en bolus unique du vécuronium, 0,1 mg · kg−1 iv. Les mesures sont comparées entre le groupe traité à la clonidine et le groupe contrôle pendant une chirurgie abdominale basse ou une chirurgie des extrémités. Une anesthésie épidurale est complétée par une anesthésie générale au fentanyl et au protoxyde d’azote-oxygène. Nous ne constatons pas de différence entre le groupe contrôle et le groupe clonidine au regard de l’installation (100 ± 6 sec (moyenne ± SE) vs 101 ± 6 sec), la durée (44,5 ± 2,7 min vs 42,9 ±2,7 min) et de l’indice de récupération (21,6 ± 2,8 min vs 19,1 ± 1,9 min). Ces résultats démontrent que la prémédication orale à la clonidine, 5 μg · kg−1, n’altère en aucune façon la curarisation induite par le vécuronium, 0,1 mg · kg−1, chez les patients qui reçoivent une anesthésie épidurale complétée par une générale au fentanyl-protoxyde d’azote.
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Takahashi, H., Nishikawa, T. Oral clonidine does not alter vecuronium neuromuscular blockade in anaesthetized patients. Can J Anaesth 42, 511–515 (1995). https://doi.org/10.1007/BF03011690
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DOI: https://doi.org/10.1007/BF03011690