Low Dose Intratechal Clonidine
Transcript of Low Dose Intratechal Clonidine
-
8/19/2019 Low Dose Intratechal Clonidine
1/32
LO W DO SE IN TR A TECH A L CLONIDINE A
FEN T A N YL A DDED TO H YPERB A
B UPI V A C A INE PROLONG S A N A LGE SI
G YNECOLOGIC A L S URG
POOJ A CHOPR A , V A ND A N A T A L W A R
DEP A R TEMEN T OF A N A E S THE SI A A ND IN TEN SI VE C
A RE, V A RDHM A N M A H A VIR MEDIC A L COLLEGE A N
S A FD A RJ A NG HO SPI T A L, NE W DELHI, INDI A
-
8/19/2019 Low Dose Intratechal Clonidine
2/32
INTRODUCTION
The study !s "#!$$ed t% !s&e't!($ () ! s*!## d%se%) %$(d($e +- *&./ he$ !dded t% ! 0u"(1!&!($e2)e$t!$y# *(3tu'e (*"'%1es s"($!# !$!#.es(!, (th%ut
"'%du&($. s(de e))e&ts, !s &%*"!'ed t% !0u"(1!&!($e2)e$t!$y# %' ! 0u"(1!&!($e2%$(d($e
*(3tu'e4
-
8/19/2019 Low Dose Intratechal Clonidine
3/32
H!e*%dy$!*(& "'%)(#eO$set !$d Le1e#
Se$s%'y B#%&5!d
I$t'!%"e'!t(1e !$d
P%st%"e'!t(1e P!($S&%'e
S(de e))e&ts !$
sed!t(%$
Du'!t(%$ %) A$!#.es(!
-
8/19/2019 Low Dose Intratechal Clonidine
4/32
MATERIAL AND
METHODS
-
8/19/2019 Low Dose Intratechal Clonidine
5/32
O0t!($($. Eth(& A""'%1!#
P'%s"e&t(1e D%u0#e B#($d R!$d%*(6e Study
I$us(%$ !$d e3us(%$ &'(te'(!
P!t(e$ts e'e '!$d%*#y !##%&!ted t% 'e&e(1e e(the' Bu"(1!Fe$t!$y# +G'%u" BF/, Bu"(1!&!($e C#%$(d($e +G'%u" BC/, BuFe$t!$y# C#%$(d($e +G'%u" BFC/
-
8/19/2019 Low Dose Intratechal Clonidine
6/32
INCLUSION CRITERIA
78 FEMALE PATIENTS ASA +AMERICAN SOCIETY OF
ANESTHESIOLOGIST/ GRADE I2II, AGED BETWEEN 982:8 YEA
WHO WERE SCHEDULED FOR VAGINAL HYSTERECTOMY WIT
PELVIC FLOOR REPAIR OR NON DESCENT VAGINAL HYSTEREC
UNDER SPINAL ANAESTHESIA4
-
8/19/2019 Low Dose Intratechal Clonidine
7/32
E;CLUSION CRITERIA
PATIENT RE
-
8/19/2019 Low Dose Intratechal Clonidine
8/32
•GROUP BF= -48> HYPERBARIC BUPIVACAINE +?4 ML/ AND FENTANY
WITH SALINE -4? ML
•GROUP BC = -48> HYPERBARIC BUPIVACAINE +?4 ML/ AND CLON
MCG/ WITH SALINE -4 ML
•GROUP BCF = -48> HYPERBARIC BUPIVACAINE +?4 ML/ AND FENTA
MCG/
AND CLONIDINE +- MCG/ WITH SALINE -4? ML
-
8/19/2019 Low Dose Intratechal Clonidine
9/32
P'e*ed(&!t(%$
• O'!# A#"'!6%#!* -4?8 *. +$(.ht!$d ? h%u's "'(%' t% su'.e'y
SAB
• P!t(e$ts e'e '!$d%*#t% %$e %) th'ee .'%u"s
• SAB !s "e')%'*ed ($ tL92L8 ($te's"!&e us($.s"($!# $eed#e ($ the #!t"%s(t(%$
-
8/19/2019 Low Dose Intratechal Clonidine
10/32
-
8/19/2019 Low Dose Intratechal Clonidine
11/32
PATIENT CHARACTERISTIC
G'%u" BF
N?8
G'%u" BC
N?8
G'%u"
N
He(.ht +&*/ @8 9 @89 9 @87
We(.ht +5./ 8- 949 848 4 84:
A.e +ye!'s/ 9:4? 4: 8@4: 4? 948
Su'.e'y du'!t(%$
+*($utes/
@?74 ?847 @@?4 ?:49 @-
-
8/19/2019 Low Dose Intratechal Clonidine
12/32
ANALGESIC DATA V!'(!0#es G'%u" BF
N?8
G'%u" BC
N?8
De'*!t%*!# S"'e!d !)te' ($t'!te&h!#
($e&t(%$ +de'*!t%*es 0#%&5ed/
@8 ? @: ?
O$set %) se$s%'y 0#%&5 +*($utes/ @74? 849 @-49 94?
I$t'!%"e'!t(1e "!($ +> %) "!t(e$ts/ 9- +$@-/ @? +$/
Re.'es(%$ t% t% se.*e$t +*($utes/ 78 - 8 8:
-
8/19/2019 Low Dose Intratechal Clonidine
13/32
ANALGESIC DATA V!'(!0#es G'%u" BF
N?8
G'%u" BC
N?8
Du'!t(%$ %) se$s%'y 0#%&5 +*($utes/ @9?4? @947 @774 94
Du'!t(%$ %) e))e&t(1e !$!#.es(! +*($utes/ @7: 9-4 ? 48
Nu*0e' %) d(%)e$!& ($e&t(%$ ($ ?9h%u's
?4:: +?2/ @4@: +@2?/
-
8/19/2019 Low Dose Intratechal Clonidine
14/32
INTRAOPERATIVE PARAMETERSI$t'!%"e'!t(1e V!'(!0#es G'%u" BF
N?8
G'%u" BC
N?8
Du'!t(%$ %) *%t%' 0#%&5 +*($utes, *e!$
SD/
@9?4? @947 @774 94
N!use! !$d V%*(tt($. +> %) "!t(e$ts/ @7: 9-4 ? 48
Sh(1e'($. +> %) "!t(e$ts/ ?4:: +?2/ @4@: +@2?/
Sed!t(%$ +> %) "!t(e$ts/ @? +$/ +$?/
-
8/19/2019 Low Dose Intratechal Clonidine
15/32
DISCUSSION
-
8/19/2019 Low Dose Intratechal Clonidine
16/32
CLONIDINE 2 MECHANISM OF ACTIO• PREDOMINANTLY ALPHA ? ADRENERGIC AGONIST ACTIVITY
•DECREASE SYMPATHETIC ACTIVITY, SYSTEMIC VASCULAR RESISTANCE, HEARBLOOD PRESSURE
• ENHANCE PARASYMPATHETIC TONE
• REDUCE CIRCULATING CATHECOLAMINE
•ITS ANALGETIC EFFECT ARE MEDIATED ENTIRELY VIA PRE AND POST SYNAPTIC
ADRENERGIC RESEPTOR THAT BLOC NOCICEPTIVE TRANSMISSION
• ANTIHYPERTENSIVE ACTION OCCURS VIA BINDING TO A NONADRENERGIC
+IMIDAOLINE/ RECEPTORM%'.!$ 8t
-
8/19/2019 Low Dose Intratechal Clonidine
17/32
CLONIDINE 2 CLINICAL USES
• ANTIHYPERTENSIVE AGENT
• ADJUNCT FOR EPIDURAL, CAUDAL, PERIPHERAL NERVE BLOC
•USED IN THE MANAGEMENT OF PATIENT WITH CRONIC NEUROPATH
M%'.!$ 8th e
-
8/19/2019 Low Dose Intratechal Clonidine
18/32
THE STUDY FOUND THAT =
@4 DERMATOMAL SPREAD TO BE WIDER?4 TIME OF ONSET OF ANALGESIA TO BE SIGNIFICANTLY LESS4 DURATION OF EFFECTIVE ANALGESIA, DURATION OF SENSORY AN
MOTOR BLOC AND TIME TO TWO SEGMENT REGRESSION WERE
SIGNIFICANTLY MORE
94 INCIDENCE OF INTRAOPERATIVE PAIN AND RE
-
8/19/2019 Low Dose Intratechal Clonidine
19/32
CONCLUSION
-
8/19/2019 Low Dose Intratechal Clonidine
20/32
-
8/19/2019 Low Dose Intratechal Clonidine
21/32
CRITICAL APPRAISAL
P : 75 female patients ASA grade I-II, aged be
45-65 years, scheduled fr !aginal hysterectwith pel!ic "r repair r nn descent !aginahysterectmy under spinal anaesthesiaI : #yperbaric bupi!acaine $ clnidine $ fent
% : hyperbaric bupi!acaine $ fentanyl andhyperbaricbupi!acaine $ clnidine
& : duratin f analgesic
-
8/19/2019 Low Dose Intratechal Clonidine
22/32
THERAPY WORSHEET
A'e the 'esu#ts %) th(s s($.#e "'e1e$t(1e %' the'!"eut(& t'(!# 1!#
W!s the !ss(.$*e$t %) "!t(e$ts t% t'e!t*e$ts
'!$d%*(sed
W!s the '!$d%*(s!t(%$ #(st &%$&e!#ed
Yes
W!s )%##%2u" %) "!t(e$ts su))(&(e$t#y #%$. !$d
&%*"#ete
Yes
We'e !## "!t(e$ts !$!#ysed ($ the .'%u"s t%
h(&h they e'e '!$d%*(sed
Yes
We'e "!t(e$ts !$d ($(&(!$s 5e"t 0#($dK t%t'e!t*e$t
Yes
We'e the .'%u"s t'e!ted eu!##y, !"!'t )'%* the
e3"e'(*e$t!# t'e!t*e$t
Yes
We'e the .'%u"s s(*(#!' !t the st!'t %) the t'(!# Yes
-
8/19/2019 Low Dose Intratechal Clonidine
23/32
C!$ y%u !""#y th(s 1!#(d, (*"%'t!$t e1(de$&e !0%ut
the'!"y ($ &!'($. )%' y%u' "!t(e$t
D% these 'esu#ts !""#y t% y%u' "!t(e$t
Is y%u' "!t(e$t s% d())e'e$t )'%* th%se
($ the study th!t (ts 'esu#ts &!$$%t
!""#y
N%
Is the t'e!t*e$t )e!s(0#e ($ y%u'
sett($.
Yes
A'e y%u' "!t(e$tMs 1!#ues !$d "'e)e'e$&es s!t(s)(ed 0y t
'e.(*e$ !$d (ts &%$seLue$&es
D% y%u' "!t(e$t !$d y%u h!1e ! e!'
!ssess*e$t %) the(' 1!#ues !$d
"'e)e'e$&es
Yes
A'e they *et 0y th(s 'e.(*e$ !$d (ts
&%$seue$&es
Yes
-
8/19/2019 Low Dose Intratechal Clonidine
24/32
CONC USION
THIS JOURNAL VALID AND
APPLICABLE
-
8/19/2019 Low Dose Intratechal Clonidine
25/32
-
8/19/2019 Low Dose Intratechal Clonidine
26/32
-
8/19/2019 Low Dose Intratechal Clonidine
27/32
CLONIDINE
-
8/19/2019 Low Dose Intratechal Clonidine
28/32
MECHANISM OF ACTION
• PREDOMINANTLY ALPHA ? ADRENERGIC AGONIST ACTIVITY
• DECREASE SYMPATHETIC ACTIVITY, SYSTEMIC VASCULAR RESISTANCE, HEART RATE, BLOOD
• ENHANCE PARASYMPATHETIC TONE
• REDUCE CIRCULATING CATHECOLAMINE
• ITS ANALGETIC EFFECT ARE MEDIATED ENTIRELY VIA PRE AND POST SYNAPTIC ALPHA ? ADRE
RESEPTOR THAT BLOC NOCICEPTIVE TRANSMISSION
• ANTIHYPERTENSIVE ACTION OCCURS VIA BINDING TO A NONADRENERGIC +IMIDAOLINE/ RE
M%'.!$ 8t
-
8/19/2019 Low Dose Intratechal Clonidine
29/32
CLINICAL USES
• ANTIHYPERTENSIVE AGENT
• ADJUNCT FOR EPIDURAL, CAUDAL, PERIPHERAL NERVE BLOC
•USED IN THE MANAGEMENT OF PATIENT WITH CRONIC NEUROPATH
M%'.!$ 8th e
-
8/19/2019 Low Dose Intratechal Clonidine
30/32
SIDE EFECTS
•SEDATION
•DIINESS
•BRADYCARDIA
•DRY MOUTH
M%'.!$ 8th e
-
8/19/2019 Low Dose Intratechal Clonidine
31/32
DOSAGE
• STARTED AT - MCGH IN A MI;TURE WITH AN OPIOID OR A LOCAL ANESTHETIC
• ORAL = -2:- MINUTES ONSET, AND LAST :2@?H
• ACUTE HYPERTENSION = -4@ MGHOUR, MA;IMUM -4:MG, MAINTENANCE DOSE ? ; -4@2-4MG
• METABOLIED BY THE LIVER AND E;CRETED RENALLY
M%'.!$
-
8/19/2019 Low Dose Intratechal Clonidine
32/32
DRUGS INTERACTION