Ventilatory effects of premedication with clonidine

Clonidine has been proposed as a premedication before surgery because of its beneficial effects on hemodynamics, especially in patients with a high cardiovascular risk. However, reports on the effects of clonidine on ventilation are conflicting. Accordingly, eight fasting ASA physical status I volunteers received in a double-blind randomized order 300 micrograms of oral clonidine, the effects of which were compared with placebo given in a crossover design. Hypotension, bradycardia, and sedation were significantly more profound and of longer duration after clonidine. Clonidine did not decrease minute ventilation more than the placebo, and separate analysis of tidal volume and respiratory rate changes also showed the absence of a significant difference between the two groups. However, clonidine produced episodes of obstructive pattern associated with moderate decreases in oxygen saturation, which were not observed with placebo. We conclude that the potential detrimental effects of these obstructive airway patterns of clonidine should be taken into account when prescribing this drug for premedication.