Changes in cerebral hemodynamics after a single dose of clonidine in severely head-injured patients

Anesthesia and Analgesia
A ter MinassianF Bonnet

Abstract

alpha 2-Adrenergic agonists induce cerebral vasoconstriction, reduce intracranial pressure (ICP) in experimental animals and may be useful in the hemodynamic management of head-injured patients. We studied the effects of the alpha 2 agonist clonidine on the cerebral circulation in 12 head-injured patients (Glasgow Coma Scale score < 8). Middle cerebral artery flow velocity (MCAV), ICP, mean arterial pressure (MAP), and cerebral perfusion pressure (CPP), were continuously recorded before (T0), at the end (T1), and 30 min after (T2) a 10-min intravenous (i.v.) infusion of 2.5 micrograms/kg clonidine. The cerebral arteriovenous oxygen content difference (AVDO2) and Paco2 were sequentially obtained. ICP, Paco2, AVDO2, and MCAV did not change after clonidine administration. In contrast, MAP and CPP decreased (P < 0.05 and P < 0.05, respectively, at T1 and T2). Three subjects displayed a transient increase in ICP (> 10 mm Hg) at T1; this increase was concomitant with the decrease in MAP. Clonidine administered as an i.v. infusion may induce a critical but transient increase in ICP in some severely head-injured patients. This effect may result from cerebral autoregulatory vasodilation and increased cerebral blood volume as a response ...Continue Reading

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Citations

May 26, 2004·Annales Françaises D'anesthèsie Et De Rèanimation·J AlbanèseM Léone
Feb 18, 2010·Current Opinion in Critical Care·Marek A Mirski, John J Lewin
Jul 1, 2005·Neurosurgery·Alex Bekker, Mary K Sturaitis
May 23, 2006·Annales Françaises D'anesthèsie Et De Rèanimation·M LeoneJ Albanèse
Mar 15, 2016·Anaesthesia Critical Care & Pain Medicine·D Longrois, L Quintin
Apr 22, 2011·Journal of Pharmacy Practice·Jason M MakiiJohn J Lewin
Jan 14, 2004·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Susan C Urwin, David K Menon

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