Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 7:2020:4750615.
doi: 10.1155/2020/4750615. eCollection 2020.

Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery

Angelina Grest  1 , Judith Kurmann  1 , Markus Müller  1 , Victor Jeger  1 , Bernard Krüger  1 , Donat R Spahn  1 , Dominique Bettex  1 , Alain Rudiger  1
Affiliations

Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery

Angelina Grest et al. Crit Care Res Pract. .

Abstract

Purpose: The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery.

Methods: 2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages).

Results: Patients receiving clonidine (n = 193) were younger (66 (57-73) vs 70 (63-77) years, p=0.003) and had a lower SAPS II (35 (27-48) vs 41 (31-54), p=0.008) compared with patients receiving dexmedetomidine (n = 141). At the start of the drug infusion, HR (90 (75-100) vs 90 (80-105) bpm, p=0.028), MAP (70 (65-80) vs 70 (65-75) mmHg, p=0.093), and norepinephrine (0.05 (0.00-0.11) vs 0.12 (0.03-0.19) mcg/kg/min, p < 0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR < 60 bpm) developed in 7.8% with clonidine and 5.7% with dexmedetomidine (p=0.51). Between baseline and 12 hours, norepinephrine remained stable in the clonidine group (0.00 (-0.04-0.02) mcg/kg/min) and decreased in the dexmedetomidine group (-0.03 (-0.10-0.02) mcg/kg/min, p=0.007).

Conclusions: Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Study population with inclusion and exclusion criteria. ECMO: extracorporeal membrane oxygenation; VAD: ventricular assist device; ICU: intensive care unit.
Figure 2
Figure 2
Drug dosages during dexmedetomidine and clonidine infusion. The clonidine and dexmedetomidine doses decreased by −0.14 (−0.35–0.00) mcg/kg/h and −0.12 (−0.69–0.21), respectively. Values indicate median ± interquartile range. Solid line (──) indicates clonidine patients; dashed line (- - -) indicates dexmedetomidine patients. Values represent median (interquartile range).
Figure 3
Figure 3
Hemodynamic variables during dexmedetomidine and clonidine infusion. Solid line (──) indicates clonidine patients; dashed line (- - -) indicates dexmedetomidine patients. Values represent median (interquartile range).
See this image and copyright information in PMC

References

    1. Jacobi J., Fraser G. L., Coursin D. B., et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical Care Medicine. 2002;30(1):119–141. doi: 10.1097/00003246-200201000-00020. - DOI - PubMed
    1. Barr J., Fraser G. L., Puntillo K., et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine. 2013;41(1):263–306. doi: 10.1097/ccm.0b013e3182783b72. - DOI - PubMed
    1. Chen K., Lu Z., Xin Y. C., Cai Y., Chen Y., Pan S. M. Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients. Cochrane Database of Systematic Reviews. 2015;1 doi: 10.1002/14651858.CD010269. - DOI - PMC - PubMed
    1. Cruickshank M., Henderson L., MacLennan G., et al. Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review. Health Technology Assessment. 2016;20(25):1–118. doi: 10.3310/hta20250. - DOI - PMC - PubMed
    1. Fehr S. B., Zalunardo M. P., Seifert B., et al. Clonidine decreases propofol requirements during anaesthesia: effect on bispectral index. British Journal of Anaesthesia. 2001;86(5):627–632. doi: 10.1093/bja/86.5.627. - DOI - PubMed

LinkOut - more resources