The Use of Clonidine in Plastic Surgery

Clonidine is a centrally acting alpha 2 agonist in chirurgia plastica. It stimulates alpha adrenoreceptors in the brain, which results in reduced sympathetic out?ow from the central nervous system. This reduction causes a decrease in peripheral vascular resistance, renal vascular resistance, blood pressure, and heart rate. The patient’s blood pressure declines within 30 to 60 minutes after an oral dose, and the maximum decrease occurs within 2 to 4 hours. The plasma half life ranges from 12 to 16 hours. The medication also has mild sedative and analgesic properties.
Clonidine has been shown to produce several useful perioperative effects, including pre operative sedation, attenuation of hemodynamic responses to endotracheal intubation, improved perioperative hemodynamic stability, diminished anesthetic requirements, and improved postoperative analgesia. Clonidine has been used as an adjunct for rhytidectomy and rhino plasty procedures to decrease intraoperative bleeding and prevent postoperative hematoma formation. Adverse side effects, including (postural) hypotension, bradycardia, lethargy, weakness, and somnolence, are dose dependent.

Major surgical procedures are performed under a deep sedation or general anesthesia with the patient intubated. If care is delivered in a properly equipped and accredited facility with quali?ed personnel for an appropriately selected ASA P1 or P2 patient, then the choice of anesthetic technique depends primarily on the procedure length and complexity and the surgeon’s comfort level. Secondary concerns include the ability of the patient to tolerate sedation and the increased cost of providing general anesthesia.
It's advisable generally use deep sedation for short to moderate length procedures in which they are con?dent that local anesthesia and sedation techniques will provide adequate patient comfort. General anesthesia is reserved for longer or more complex procedures in which there is concern for protecting the patient’s airway (ie, rhinoplasty) or maintaining adequate anesthesia to keep the patient comfortable and prevent excessive movement.
Apnea and hypotension, side effects seen with propofol, usually do not occur during this initial bolus because of stimulation from local anesthesia injection. If apnea or obstruction does occur, a gentle chin lift is usually sufficient to support ventilation. Pain on injection can be a problem with propofol. Pain can be minimized if larger antecubital veins are utilized. Intermittent boluses can be given to deepen a patient’s sedation when necessary. If hypotension or apnea arises, the infusion rate is decreased or held for a short period. A ?uid bolus can be given if needed to support pressure. Side effects are usually self-limiting because of propofol’s rapid clearance.

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