Volume 10 Supplement 1

de Senectute: Age and Health Forum

Open Access

Use of clonidine following the weaning phase of the elderly patients underwent elective on-pump cardiac surgery: a prospective randomized study

  • S Caroleo1,
  • F Onorati2,
  • O Bruno1,
  • D Vuoto1,
  • F Infelise1,
  • A Rubino2,
  • E Santangelo3,
  • A Renzulli2 and
  • B Amantea1
BMC Geriatrics201010(Suppl 1):A97

https://doi.org/10.1186/1471-2318-10-S1-A97

Published: 19 May 2010

Background

Alpha-2 adrenergic agonists reduce mortality and myocardial infarction following vascular and cardiac surgery [1]. Few data exist about the weaning phase in this setting.

Materials and methods

Design:Analysis of a prospective and randomized collected database.

Setting:Intensive Care Unit (ICU) in an University Hospital.

Patients:A total of 45 patients aged >65 (26 M, 19 F; ASA II-III) submitted to elective on-pump cardiac surgery from November 2007 to June 2008.

Randomization:On ICU admission the patient was assigned to group 1 (Clonidine, intervention group) or group 2 (Placebo, control group).

Interventions:Group 1 received intravenous (IV) bolus of Clonidine 0.5 microg/kg followed by continuous infusion of 1 – 2 microg/kg/hr all over the weaning protocol phase. Group 2 received IV continuous infusion of Sodium Chloride 0.9% all over the weaning phase.

Data collection: We evaluated hemodynamic parameters, Troponin I (TnI) blood levels, weaning parameters, Delirium Detection Score (DDS), weaning duration and ICU length of stay. The patients were evaluated preoperatively (T0), on ICU admission (T1), after 6 hours (T2) and 30 minutes after the start of weaning protocol (T3).

Results

No differences in preoperative and operative variables (p=NS for all measurements). The incidence of postoperative atrial fibrillation was lower in group 1 (p<0.001). Following the weaning phase, Heart Rate, Mean Pulmonary Arterial Pressure and Pulmonary Arterial Occlusion Pressure were lower in group 1 (respectively p<0.001, p=0.019 and p=0.037). The TnI levels was lower in group 1 (p=0.05). The ratio of respiratory rate and tidal volume (RR/TV) and the product of RR and pressure support (RR x PS) were lower in group 1 (both p<0.001); the ratio of PaO2 and FIO2 (PA/FI) and PaCO2 were higher in group 1 (respectively p=0.0035 and p<0.001). DDS was lower in group 1 (p=0.0028). Weaning duration and ICU length of stay were similar in the two groups (p=NS).

Conclusions

The use of Clonidine in this setting reduce the stress-response during the weaning phase, improving hemodynamic stability and myocardial protection.

Authors’ Affiliations

(1)
Deparment of Anaesthesia and Reanimation, University of Catanzaro
(2)
Department of Cardiac Surgery, University of Catanzaro
(3)
Department of Anaesthesia and Oncological Intensive Care

References

  1. Wijeysundera DN, Naik JS, Beattie WS: Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med. 2003, 114 (9): 742-52. 10.1016/S0002-9343(03)00165-7.PubMedView ArticleGoogle Scholar

Copyright

© Caroleo et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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