Author/Editor		Novak-Jankovič, Vesna
Title		Učinki epiduralnega in intravenskega klonidina na nevroendokrini, imunski, hemodinamski in presnovni stresni odgovor ter porabo propofola pri bolnikih, operiranih na pljučih
Type		monografija
Place		Ljubljana
Publisher		Medicinska fakulteta
Publication year		2000
Volume		str. 59
Language		slo
Abstract		The effects of epidural or intravenous clonidine, combined with epidural morphine, on the neuroendocrine, immune, haemodynamic and metabolic stress responses and propofol requirements were studied in a prospective randomised double blind study. In all 60 patients, an epidural catheter was inserted between the 6th and 7th thoracic vertebrae. The epidural group (n = 20) received clonidine, 4 micro g kg-1, and morphine, 40 micro g kg-1, via the epidural catheter. The intravenous group (n = 20) received clonidine, 4 micro g kg-1, in i.v. infusion and epidural morphine, 40 micro g kg-1. The control group (n = 20) received only epidural morphine, 40 micro g kg-1. Arterial blood samples for the analyses of adrenaline, noradrenaline, vasopressin, cortisol, beta endorphin, total and differential leucocyte counts, glucose and free fatty acids (FFA) were collected before the administration of drugs (T1), immediately after intubation (T2), after thoracotomy (T3) and at the enf of surgery (T4). Intraoperative monitoring included ECG and continuous measurement of blood pressure in the radial artery. The plasma levels of adrenaline and noradrenaline were within the normal range at all sampling times in all three groups and showed no significant differences between the groups. Compared to baseline values, the values of vasopressin were significantly elevated in all groups at T3 and T4 (+p < 0.001), cortisol levels were significantly elevated in all groups at T4 (+p < 0.001), and beta-endorphin levels were significantly elevated in all groups at T3 and T4 (+p < 0.001). The total leucocyte and segmented neurophil counts were significantly elevated in all groups at T4 (+p < 0.001); the increased values were significantly lower in both clonidine groups, compared to the control group (*p < 0.001); and they were significantly lower in the epidural group, compared to the intravenous group (delta p < 0.01).(Abstract truncated at 2000 characters).
Descriptors		CLONIDINE STRESS THORACOTOMY ANESTHESIA, EPIDURAL LUNG DISEASES INFUSIONS, INTRAVENOUS MORPHINE INTRAOPERATIVE PERIOD POSTOPERATIVE PERIOD NOREPINEPHRINE VASOPRESSINS HYDROCORTISONE BETA-ENDORPHIN LEUKOCYTE COUNT BLOOD GLUCOSE FATTY ACIDS, UNSATURATED BLOOD PRESSURE ELECTROCARDIOGRAPHY