Clonidine in the management of blood pressure during rhytidectomy

Blood pressure control is an important part of any surgical procedure and is especially important during rhytidectomy to reduce the risk of bleeding, improve visualization, and reduce the risk of postoperative fluid accumulations. For patients given general anesthetic, b blood pressure control is regulated by intravenous fluids, inhalational gas concentrations, and pharmacologic manipulation. For those given local anesthetic with intravenous sedation, blood pressure manipulation can be difficult. Clonidine (Catapres, Boehringer Ingelheim) has been shown to effectively reduce blood pressure in individuals with hypertension, as well as those with normal blood pressure. We compared both intraoperative and postoperative blood pressure, pulse, and drug use, as well as complications in 100 patients treated with preoperative oral clonidine (0.1 mg) and in 100 patients who did not receive clonidine. The group that received clonidine had reduced systolic, diastolic, and mean blood pressure, and pulse rate (114/64, 80, 79 vs 129/74, 92, 86, p<0.001). Blood pressure measured 12 hours after surgery remained lower in the clonidine group (119/67 vs 126/72, p<0.001). There was no difference in intraoperative diazepam (Valium) or midazolem (Versed) requirements. Intraoperative fentanyl requirements were lower in the non-Catapres-treated group. Postoperative narcotic requirements were reduced in the clonidine-treated group. The patients treated with clonidine had a lower rate of hematoma and postoperative antihypertensive drug requirement than the untreated group. We propose that clonidine is a safe and effective drug to use in the perioperative period in patients undergoing rhytidectomy to regulate blood pressure.