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GENERAL ARTICLES

The Effects of Clonidine Premedication on Sevoflurane Requirements and Anesthetic Induction Time

Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan

Address correspondence and reprint requests to Dr. Inomata, Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305, Japan.

We assessed the effects of oral clonidine preanesthetic medication (4.5 µg/kg) on the vital capacity rapid-inhalation anesthetic induction time (VCRII time) and minimum alveolar anesthetic concentration (MAC) to prevent a response to a verbal command in 50% of patients (MAC-Awake) by its hypnotic effect, and on MAC-Skin incision for the analgesic effect in patients anesthetized with sevoflurane. We studied 104 adult patients (control group: n = 52, clonidine group: n = 52) aged 30–48 yr scheduled to undergo general anesthesia. Fifty-two patients received oral clonidine 4.5 µg/kg 1.5 h before arrival in the operating room (clonidine group). The patients exhaled to residual volume and took three vital capacity breaths of 5% sevoflurane in oxygen. The VCRII time was defined as the time interval between the initiation of the VCRII and the disappearance of the response to verbal command. Anesthesia was maintained with sevoflurane in oxygen and air. The end-tidal (ET) sevoflurane concentration reached a predetermined value, then the ratio of predetermined ET to inspiratory concentration was maintained at 0.95 for at least 15 min before skin incision. After skin incision, the patients were observed for gross purposeful muscular movements. MAC was defined as the average of the cross-over midpoints in each cross-over. After maintaining the ET sevoflurane concentration for 15 min, patients were judged to be awake or asleep. Average times for VCRII using 5% sevoflurane were achieved in 44 ± 11 s (mean ± SD) and 27 ± 6 s in the control and clonidine groups, respectively (P = 0.0001). MAC-Awake values of sevoflurane were 0.66% ± 0.03% and 0.35% ± 0.02% (P = 0.0001), and MAC-Skin incision values were 1.97% ± 0.19% and 1.29% ± 0.13% (P = 0.0001) in the control and clonidine groups, respectively. These results suggest that clonidine may have a more potent hypnotic effect than analgesic effect.

Implications: Oral clonidine preanesthetic medication (4.5 µg/kg) significantly reduces vital capacity rapid inhalation anesthetic induction time and minimum alveolar anesthetic concentration awake for sevoflurane.

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