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CARDIOVASCULAR ANESTHESIA

Propofol Anesthesia Enhances Pressor Response to Ephedrine in Patients Given Clonidine

Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, Gifu City, Japan

Address correspondence and reprint requests to Shuji Dohi, MD, Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan. Address e-mail to shu-dohi{at}cc.gifu-u.ac.jp

We studied the hemodynamic effects of ephedrine in patients with or without clonidine premedication during either isoflurane or propofol anesthesia. Forty adult patients were randomly assigned to one of two groups: 20 patients received famotidine 20 mg orally (control group) and 20 received clonidine 3 µg/kg and famotidine 20 mg orally (clonidine group). Within each group, 10 patients were then anesthetized with isoflurane and 10 with propofol. Hemodynamic measurements were taken at 1-min intervals for 10 min after a bolus injection of ephedrine 0.1 mg/kg. The magnitude of the maximal pressor response to ephedrine was no different whether patients without clonidine were anesthetized with isoflurane (increase 5 ± 7 mm Hg) or propofol (3 ± 9 mm Hg); however, this response was greater (P < 0.05) with propofol (17 ± 6 mm Hg) versus isoflurane (6 ± 5 mm Hg) in patients given clonidine. The arterial blood pressure increase in clonidine-premedicated patients with propofol anesthesia was the largest among the four subgroups. The heart rate response to ephedrine was not significant in patients anesthetized with isoflurane and was small but significant in those anesthetized with propofol. The present results, together with previous studies on the effect of ephedrine in patients medicated with clonidine, suggest that the interaction between clonidine and ephedrine is modulated by the anesthetic used.

Implications: We evaluated the pressor response to ephedrine during isoflurane or propofol anesthesia with or without clonidine premedication. Our study suggests that, in anesthetized patients premedicated with clonidine, decreases in blood pressure may be easier to reverse with ephedrine with some types of anesthesia (e.g., propofol) than with others (e.g., isoflurane).

This article has been cited by other articles:

				T. Ishiyama, S. Kashimoto, T. Oguchi, T. Matsukawa, and T. Kumazawa The Effects of Clonidine Premedication on the Blood Pressure and Tachycardiac Responses to Ephedrine in Elderly and Young Patients During Propofol Anesthesia Anesth. Analg., January 1, 2003; 96(1): 136 - 141. [Abstract] [Full Text] [PDF]

				N. Kanaya, H. Satoh, S. Seki, M. Nakayama, and A. Namiki Propofol Anesthesia Enhances the Pressor Response to Intravenous Ephedrine Anesth. Analg., May 1, 2002; 94(5): 1207 - 1211. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999