Attenuation of systemic inflammatory stress response after preoperative analgesia with clonidine compared to levobupivacaine-a randomised clinical trial

Background and purpose: Use of analgetics before the pain stimulus (preventive analgesia) obstruct development of neuroplastic changes in central nervous system, and reduces pain. Furthermore, preventive analgesia can block harmful central nervous system response and inflammation as an early consequence of operation as well. Investigation hypothesis is that preoperative central clonidine will reduce systemic inflammatory stress response better than levobupivacaine. Materials and methods:. Patients were allocated to three groups, according to preoperative epidural use of 5 μg/kg clonidine (n=17), 0.25% levobupivacaine (n=12) or saline as control group (n=13). Before operation, 1 h after the beginning, 1 h, 6 h, 12 h and 24 h after the operation following parameters were analyzed: procalcitonin (PCT), interleukine-6 (IL-6), C-reactive protein (CRP) and lactate. Results: There were no significant differences between groups in age, gender, body mass index and operation time. We demonstrated significant reduction in PCT, IL-6, CRP and lactate levels in preoperative clonidine group, compared to preoperative levobupivacaine group and controle group. Conclusion. These results support importance of clonidine central effect on pain pathways and systemic inflammatory stress response blockade

Attenuation of systemic inflammatory stress response after preoperative analgesia with clonidine compared to levobupivacaine-a randomised clinical trial

Background and purpose: Use of analgetics before the pain stimulus (preventive analgesia) obstruct development of neuroplastic changes in central nervous system, and reduces pain. Furthermore, preventive analgesia can block harmful central nervous system response and inflammation as an early consequence of operation as well. Investigation hypothesis is that preoperative central clonidine will reduce systemic inflammatory stress response better than levobupivacaine. Materials and methods:. Patients were allocated to three groups, according to preoperative epidural use of 5 μg/kg clonidine (n=17), 0.25% levobupivacaine (n=12) or saline as control group (n=13). Before operation, 1 h after the beginning, 1 h, 6 h, 12 h and 24 h after the operation following parameters were analyzed: procalcitonin (PCT), interleukine-6 (IL-6), C-reactive protein (CRP) and lactate. Results: There were no significant differences between groups in age, gender, body mass index and operation time. We demonstrated significant reduction in PCT, IL-6, CRP and lactate levels in preoperative clonidine group, compared to preoperative levobupivacaine group and controle group. Conclusion. These results support importance of clonidine central effect on pain pathways and systemic inflammatory stress response blockade

Short- and long-term outcome of patients aged 65 and over after cardiac surgery

To analyze the short and long-term outcome of patients aged 65 years and over, after cardiac surgery. Over a 12-year period we analyzed 1750 patients with a mean age of 70.09 3.94 years. They were classified into three age groups: between 65 and 69 (n = 709), between 70 and 74 (n = 695) and 75 years and above (n = 346). Follow-up information was obtained by telephone conversation after a 6-month and 3-year period of discharge from the hospital. Included in the follow-up were 1235 patients and an interview was conducted with 501 (40.6%) patients or their next of kin. Even though the in-hospital morbidity was highest in the oldest age group, there were no significant differences between groups (p = 0.051). There was no significant difference between groups in the length of hospital stay. The greatest in-hospital mortality was noted in the oldest age group (p = 0.046) compared to patients in the age groups between 65 and 69 and between 70 and 74 years old (p = 0.023 and p = 0.036). In the follow-up study, there was a significantly smaller telephone feedback response in the oldest age group compared to the youngest group (p = 0.003). There were no differences between the groups with respect to mortality and cardiac death after the 6-month and 3-year periods of discharge from hospital. Our data showed that despite a poor short – and long-term outcome in patients aged 75 and over, all patients had an acceptable operative risk

Effect of clonidine on the cutaneous silent period during spinal anesthesia

Aim: To investigate the effect of clonidine on the cutaneous silent period (CSP) during spinal anesthesia. ----- Methods: A total of 67 adult patients were included in this randomized, prospective, single-center, double-blind trial. They did not have neurological disorders and were scheduled for inguinal hernia repair surgery. This trial was registered on ClinicalTrials.gov (NTC03121261). The patients were randomized into two groups with regards to the intrathecally administered solution: (1) 15 mg of 0.5% levobupivacaine with 50 µg of 0.015% clonidine, or (2) 15 mg of 0.5% levobupivacaine alone. There were 34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group. CSP and its latency were measured four times: prior to the subarachnoid block (SAB), after motor block regression to the 0 level of the Bromage scale, with ongoing sensory blockade, and both 6 and 24 h after SAB. ----- Results: Only data from 30 patients in each group were analyzed. There were no significant differences between the groups investigated preoperatively and after 24 h. The CSP of the L group at the time point when the Bromage scale was 0 was 44.8 ± 8.1 ms, while in the LC group it measured 40.2 ± 3.8 ms (P = 0.007). The latency in the L group at the time point when the Bromage scale was 0 was 130.3 ± 10.2 ms, and in the LC group it was 144.7 ± 8.3 ms (P < 0.001). The CSP of the L group after 6 h was 59.6 ± 9.8 ms, while in the LC group it was 44.5 ± 5.0 ms (P < 0.001). The latency in the L group after 6 h was 110.4 ± 10.6 ms, while in LC group it was 132.3 ± 9.7 ms (P < 0.001). ----- Conclusion: Intrathecal addition of clonidine to levobupivacaine for SAB in comparison with levobupivacaine alone results in a diminished inhibitory tonus and shortened CSP