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CARDIOVASCULAR ANESTHESIA

Clonidine-Induced Vasoconstriction in Awake Volunteers

Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, California

Address correspondence and reprint requests to Dr. Talke, Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, CA 94143-0648. Address e-mail to talkep{at}anesthesia.ucsf.edu

We evaluated the vasomotor effects of clonidine in awake subjects with an intact central cardiovascular regulatory system. To determine the lower limit of the vasoconstrictive effect of clonidine in awake volunteers, we blocked sympathetic innervation to the left arm by anesthetizing the brachial plexus. We then measured arterial blood pressure and vasoconstriction via finger volume plethysmography measuring infrared light transmitted through a fingertip (LTF). LTF values obtained from the left arm were compared with those from the neurally intact right arm during four progressively increasing IV doses of clonidine, targeting plasma clonidine concentrations of 0.3, 0.45, 0.68, and 1.0 ng/mL. Clonidine decreased systolic blood pressure (P < 0.004) from 135 ± 8 mm Hg to 115 ± 8 mm Hg and heart rate (P = 0.0017) from 68 ± 7 mm Hg to 61 ± 10 mm Hg. Clonidine decreased LTF by -12% ± 11% (P < 0.0001) less than preinfusion values at the 0.68 ng/mL target concentration in the right hand. In contrast, in the left hand, clonidine increased LTF significantly more than (P < 0.0001) preinfusion values at all target concentrations, with a maximal increase of 30% ± 7%. We conclude that IV clonidine, at doses that decrease arterial blood pressure, causes arterial vasoconstriction in awake subjects.

IMPLICATIONS: IV clonidine, at doses that decrease blood pressure, causes arterial vasoconstriction in awake subjects. These data suggest that an -2 agonist with a high -2a/-2b selectivity should provide more profound sedative and analgesic effects with less undesirable vasoconstrictive effects.

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