Effects of intravenous clonidine on the secretion of growth hormone in the perioperative period.

De Kock, Marc [UCL] Merello, L. Pendeville, Philippe [UCL] Maiter, Dominique [UCL] Scholtes, Jean-Louis [UCL]

Growth hormone (GH) improves the metabolic and immunitary parameters in the postoperative period. Clonidine, a central acting alpha 2-adrenoceptor agonist stimulates GH release and is currently used as a screening test for GH-deficiency. A continuous iv infusion of clonidine may lead to a sustained increase in GH secretion during the perioperative period. With institutional approval and after informed consent, 20 healthy (ASA 1) patients scheduled for functional middle ear surgery under deliberate hypotensive anesthesia were studied. The anesthetic technique consisted of isoflurane, fentanyl and atracurium. Patients were randomly assigned to two groups. In group 1, hemodynamic stabilisation was obtained with a loading dose of clonidine (4 micrograms.kg-1 in 30 min) and maintained with an infusion of 1 microgram.kg-1.h-1. In group 2, a loading dose of labetalol 0.2 mg.kg-1 was followed by an infusion of 0.1 mg.kg-1.h-1. These infusions were stopped 30 min. before the end of the procedure. GH and glucose concentrations were assayed before the induction of anesthesia, after the loading dose and every 30 min. during the procedure and after the recovery during 2 hours. Serum clonidine levels were assayed after the loading dose, 1 and 3 hours later. Somatomedin C (IGF-I) concentration was measured before the induction and in the first postoperative morning along with GH, glucose and clonidine.(ABSTRACT TRUNCATED AT 250 WORDS)