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Cited by 41Anesthesia and Sedative AgentsAnesthesia and Pain ManagementVeterinary Pharmacology and Anesthesia

The effect of clonidine or midazolam premedication on perioperative responses during ketamine anesthesia

Taittonen, Markku T., Kirvela, Olli A., Aantaa, Riku, Kanto, Jussi H.·1998·Anesthesia & Analgesia
DOI 10.1213/00000539-199807000-00034
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Abstract

The use of ketamine as a sole anesthetic induces marked central sympathetic stimulation, causing increased heart rate, blood pressure (BP), and oxygen consumption (VO2).Both alpha2-agonists and benzodiazepines have been used to attenuate these potentially harmful ketamine-induced responses. This double-blind, randomized, placebo-controlled study was designed to compare the perioperative metabolic, hemodynamic, and sympathoadrenal responses to IM clonidine (2 [micro sign]g/kg) and midazolam (70 [micro sign]g/kg) premedication during ketamine anesthesia. VO2 was measured continuously using indirect calorimetry in 30 ASA physical status I patients. The patients received ketamine, mivacurium, and fentanyl for the induction of anesthesia. Anesthesia was maintained using a ketamine infusion and fentanyl boluses IV. Preoperatively, both VO2 and BP decreased significantly after the administration clonidine and midazolam compared with placebo (P < 0.01). Intraoperatively, VO2 was higher in the midazolam group than in the placebo and clonidine groups (P < 0.05). Postoperatively, there were no significant differences in BP and VO2, although they stayed at lower level in the clonidine group during the whole postoperative period. Clonidine decreased pre- and postoperative plasma catecholamine concentrations (P < 0.05). Our results indicate that a midazolam-ketamine combination may induce potentially harmful metabolic stimulation, whereas the sympatholytic effects of clonidine on ketamine-anesthetized patients may be beneficial, as perioperative VO2 was decreased. Implications: Ketamine causes sympathetic stimulation with an ensuing increase in oxygen consumption. Anticipating that clonidine might attenuate this response, we measured oxygen consumption in patients undergoing surgery during ketamine anesthesia. Patients treated with a clonidine-ketamine combination had lower intra- and postoperative oxygen consumption than those treated with a midazolam-ketamine combination. (Anesth Analg 1998;87:161-7)

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Crossref · 10.1213/00000539-199807000-00034

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  • NMDA-receptor antagonists such as MK801, ketamine, and phencyclidine cause symptoms similar to anti-NMDA-receptor encephalitis, including psychotic behaviour, signs of involvement of dopaminergic pathways, and autonomic dysfunction.

    “Consistent with this antibody-induced decrease in the numbers of NMDA receptors, several NMDA-receptor antagonists such as MK801, ketamine, and phencyclidine cause symptoms similar to anti-NMDA-receptor encephalitis, including psychotic behaviour,21,22 signs of involvement of dopaminergic pathways (rigidity, dystonia, orofacial movements, tremor)22–25 and autonomic dysfunction (cardiac dysrhythmia”

    From Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies (2008) · cites this paper as [26]

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Authors
Taittonen, M. T., Kirvela, O. A., Aantaa, R., & Kanto, J. H.
Affiliations
Turku University Hospital (FI)
Corresponding author
Taittonen, Markku T.
ORCID
Taittonen, Markku T.
Venue
Anesthesia & Analgesia
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1998-07
Volume
87
Issue
1
Pages
161-167
ISSN
0003-2999 (ISSN-L)
DOI
10.1213/00000539-199807000-00034
OpenAlex
W4236930921
Cited by
41
References
19
Citations by year
2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 4 · 2013: 1
FWCI
1.94
Type
journal article
Language
en
Open access
closed
Locations
  • Anesthesia & Analgesia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Veterinary › Small Animals › Veterinary Pharmacology and Anesthesia
Keywords
clonidine, midazolam, ketamine anesthesia, premedication, oxygen consumption, sympathoadrenal response, alpha-2 adrenergic agonists, benzodiazepines, plasma catecholamines, hemodynamic response
MeSH terms
Adrenergic alpha-Agonists, Adult, Anesthesia, Adjuvants, Anesthesia, Anesthetics, Dissociative, Blood Pressure, Carbon Dioxide, Clonidine, Double-Blind Method, Drug Interactions, Epinephrine, Female, Heart Rate, Humans, Ketamine, Male, Midazolam, Middle Aged, Norepinephrine, Oxygen, Oxygen Consumption, Placebos, Premedication

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