Effects of clonidine and superficial cervical plexus block on hemodynamic stability after carotid endarterectomy

Jan Wallenborn, Volker Thieme, Gundi Hertel-Gilch, Katharina Gräfe, Olaf Richter, Lutz Schaffranietz
Journal of Cardiothoracic and Vascular Anesthesia 2008, 22 (1): 84-9

OBJECTIVES: To evaluate the effects of 2 interventions (intravenous clonidine and superficial cervical block) on hemodynamic stability after carotid endarterectomy and to identify variables associated with hemodynamic instability.

DESIGN: Prospective, observational study, sequential enrollment.

SETTING: University hospital.

PARTICIPANTS: Two hundred seventy-five patients undergoing elective carotid endarterectomy under general anesthesia.

INTERVENTIONS: Group NN (n = 50) received no intervention. In group CN (n = 85), 3 mug/kg of clonidine were administered intravenously 30 minutes before the end of the operation. Group CB (n = 140) additionally received a superficial cervical plexus block (SCB) with 20 mL of naropine 0.5% before the induction of anesthesia.

MEASUREMENTS AND MAIN RESULTS: Clonidine alone (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.45-3.76) and clonidine combined with an SCB (OR, 4.99; 95% CI, 3.19-7.82) resulted in a significant increase in hemodynamic stability after CEA (p < 0.001) from 53.3% (NN) to 70.0% (CN) and 83.3% (CB), respectively. The need for rescue medication decreased from 40.0% to 17.6% and 13.6% (p < 0.001). Both interventions significantly reduced the need for postoperative opioid analgesics (p < 0.01). Logistic regression analysis showed preoperative systolic blood pressure values greater than 170 mmHg (OR, 3.23; 95% CI, 1.76-5.93), previous cardiac interventions (OR, 3.3; 95% CI, 1.54-7.11), and the need for rescue medication in the awakening period (OR, 5.8; 95% CI, 2.88-11.52) to be independent risk factors for postoperative hemodynamic instability (p < or = 0.002).

CONCLUSIONS: Intravenous clonidine and superficial cervical block significantly improve cardiovascular stability after carotid endarterectomy. Patients with pre-existing excessive hypertension and previous coronary interventions must be considered a high-risk group.

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