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GENERAL ARTICLES

The Effect of Clonidine Pretreatment on the Perioperative Proinflammatory Cytokines, Cortisol, and ACTH Responses in Patients Undergoing Total Abdominal Hysterectomy

Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address correspondence and reprint requests to Myung H. Kim, Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul, Korea 135-710. Address e-mail to mhkim{at}smc.samsung.co.kr

We investigated the hypothesis that oral clonidine premedication would decrease the release of proinflammatory cytokines interleukin (IL)-6, IL-1ß, and tumor necrosis factor-, and stress hormones cortisol and adrenocorticotropic hormone (ACTH), in patients who underwent total abdominal hysterectomy. Twenty patients were randomly assigned to one of two groups: the control group received no premedication, whereas the treatment group received clonidine 0.15 mg oral dose 90 min before surgery. Venous blood samples were obtained at preinduction time and immediately, 1, and 3 h after the start of surgery. IL-6 increased significantly at 3 h, and cortisol and ACTH at 1 and 3 h after the start of surgery compared with the baseline values within both groups. IL-1ß levels decreased at all times compared with the baseline value in the control group. In the comparison study between the control group and the clonidine group, there was a significant decrease in IL-6 level 3 h after the start of surgery and IL-1ß at preinduction time in the clonidine group, whereas there were no changes in tumor necrosis factor-, cortisol, and ACTH levels. These results show that clonidine modulates the IL-6 response related to surgical stress.

Implications: We assessed the effect of the ₂-adrenoreceptor agonist clonidine on the immunoendocrine activity during the perioperative period. Clonidine 0.15 mg given as oral premedication resulted in the reduced Interleukin-6 production in response to total abdominal hysterectomy.

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