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significant complications. An additional benefit of some cannulation pre-treatments is cutaneous vasodilation. Previous medical anesthesia/sedation studies have indicated that clonidine administration prior to surgery decreases pain 11 12 and anxiety 12 and also stabilizes blood pressure and heart rate by reduction of central sympathetic outflow. 13–15 Additional investigations have shown that clonidine pretreatment also increases skin temperature 16 and decreases the difference between fingertip and forearm temperatures. 17 These results suggest an increase in

neurotransmitter release from the presynaptic neuron. 3 The α-receptor antagonists prazosin and yohimbine were used to further subclassify these receptors as α-1 and α-2. 4 Later, many α-2 adrenergic agonists were developed for use in the clinical setting, including their use as anesthesia adjuncts. The use of α-2 agonists as adjuncts gained popularity when early reports by Brodsky and Bravo 5 found that withholding a single dose of clonidine prior to anesthesia caused a patient to experience an acute hypertensive crisis. It was discovered that α-2 agonists produce effects

arrest, 162 Central sensitization, 135 Children, 140 Chloral hydrate, 91 Clonidine, 31 Colloids, 169 Conscious sedation, 91 Crystalloids, 168 Day case, 8 Dental, 46 Dental anesthesia, 14, 110 Dental injury, 20 Dental treatment, 91 Dentistry, 25, 168 Dexmedetomidine, 31 Diazepam, 91 Difficult intubation, 20 Emergency rescue, 74 End-tidal carbon dioxide, 51 Endobronchial intubation, 66 Endotracheal tube, 166

and the differences of the outpatient anesthesia experience to his medical colleagues, and this book provides the forum to expound on the insights he has gathered over the years. Dr Friedberg has been an innovator of the technique and concept he has coined “minimal invasive anesthesia” or “MIA.” Dr Friedberg contends that using a drug combination of propofol, ketamine, and clonidine combined with the use of bispectral index (BIS) monitoring makes outpatient anesthesia for cosmetic surgery simple, safe, and effective. Rather than being supported by peer

action of some anesthetic agents. In dental practice, vasoconstrictors are often administered with local anesthetics to increase the effect of the latter. The localization of lidocaine may be prolonged by the vasoconstrictor effect of DEX via its agonistic activity on peripheral alpha-2 blood vessel receptors. 17 – 19 Another possible mechanism for the action of DEX administered with lidocaine may be through the inhibition of neurotransmission. Clonidine is an alpha-2 receptor agonist, which has been shown to inhibit neurotransmission, 20 , 21 and thereby

. Aortic surgery: effect of clonidine on intraoperative catecholaminergic and circulatory stability. Acta Anaesthesiol Scand 1990 . 34 : 132 – 137 . 4 Aho , M. , A-M. Lehitinen , O. Erkola , A. Kallio , and K. Kortilla . The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology 1991 . 74 : 997 – 1002 . 5

receptors results in a decrease in afferent pain transmission and produces analgesia. 25 Hypotension and bradycardia are the most common adverse events and are more common with continuous IV infusions. Overall, alpha-2 adrenergic agonists provide a relatively safe hemodynamic, respiratory, and pharmacologic profile that provides clinically relevant sedation without significant respiratory depression. 23 Clonidine Originally intended as an antihypertensive agent, clonidine received US FDA approval for the treatment of attention