Oral clonidine premedication decreases energy expenditure in human volunteers

  • Hiroshi Takahashi
  • Toshiaki Nishikawa
  • Taro Mizutani
  • Fumi Handa
Reports of Investigation



Clonidine not only stops postoperative shivering and decreases oxygen consumption, but also decreases energy expenditure with or without a reduction in shivering during recovery from anaesthesia. It is important to see if clonidine decreases energy expenditure at rest since this may contnbute to a postoperative decrease in energy expenditure. The authors tested the hypothesis that oral clonidine decreases energy expenditure at rest.


Twenty healthy male volunteers were randomly assigned to one of two groups. Ten volunteers received oral clonidine approximately 5 μg·kg−1 (clonidine group), while the remaining 10 volunteers received placebo (control group). Blood pressure, heart rate, body temperature at the tympanic membrane, sedation score graded from 1 (alert) to 5 (sleeping and difficult to be aroused by tactile stimulation) were measured before and at 30-mm intervals for three hours after administration of clonidine or placebo. Measurements of energy expenditure and respiratory quotient were made with a head canopy system at one-minute intervals and averaged over 15 mm before, and at 30, 60, 90, 120, and 180 min after administration of clonidine or placebo.


Sedation score increased from 1 to 3 (median) after clonidine administration. Energy expenditure decreased from 1452± 225 kcal·24hr (mean± SD) at baseline to 1258 ± 175 kcal·24hr at 180 min after clonidine administration (P < 0 05).


This study suggests that oral clonidine at a dose of 5 μg·kg−1 decreases energy expenditure at rest.


Clonidine Tympanic Membrane Basal Metabolic Rate Respiratory Quotient Tactile Stimulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



En plus de prévenir le frisson postopératoire et de diminuer la consommation en oxygène, la clonidine diminue la dépense énergétique au moment du réveil avec ou sans atténuation du frisson. Il est important de savoir si la clonidine diminue la dépense énergétique au repos étant donné que cet effet contribue a une baisse postopératoire de l’énergie dépensée.


Vingt volontaires en bonne santé de sexe masculin étaient assignés aléatoirement à deux groupes. Dix de ces volontaires recevaient environ 5 μg·kg−1 de clonidine (groupe clonidine) alors que les autres recevaient un placebo (groupe contrôle). La pression artérielle, la fréquence cardiaque, la température corporelle et tympanique, le score de sedation coté sur une échelle de I (alerte) à 5 (endormi et difficile à réveiller par stimulation tactile) étaient notés avant et à 30 min d’intervalles pendant trois heures suivant l’administration de la clonidine ou du placebo. Les mesures de la dépense énergétique et du quotient respiratoire étaient réalisées à l’aide d’un casque et leurs moyennes calculées sur une pénode de 15 min avant et 30, 60, 90, 120 et 180 min après l’administration de la clonidine ou du placebo.


Le score de sedation a augmenté de 1 à 3 (médiane) après l’administration de la clonidine. La dépense énergétique a diminué de 1452 ± 225 kcal·24h−1 (moyenne ± ET) initialement, à 1285 ± 175 kcal·24h 180 min après l’administration de la clonidine (P < 0,05).


Cette étude suggère qu’au repos, la clonidine orale 5 μg·kg−1 diminue la dépense énergétique.


  1. 1.
    Marshall HW, Stoner HB. Catecholaminergic α-receptors and shivering in the rat. J Physiol (Lond) 1979; 292: 27–34.Google Scholar
  2. 2.
    Maxwell GM. The effects of 2-(2,6-dichlorphenylamine)-2-imidasoline hydrochloride (Catapres®) upon the systemic and coronary haemodynamics and metabolism of intact dogs. Arch Int Pharmacodyn 1969; 181: 7–14.PubMedGoogle Scholar
  3. 3.
    Capogna G, Celleno D. I.V. clonidine for post-extradural shivering in parturients: a preliminary study. Br J Anaesth 1993; 71: 294–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Flacke JW, Bloor BC, Flacke WE, et al. Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology 1987; 67: 11–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Quintin L, Roudot F, Roux C, et al. Effect of clonidine on the circulation and vasoactive hormones after aortic surgery. Br J Anaesth 1991; 66: 108–15.PubMedCrossRefGoogle Scholar
  6. 6.
    Quintin L, Viale JP, Annat G, et al. Oxygen uptake after major abdominal surgery: effect of clonidine. Anesthesiology 1991; 74: 236–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Guyton AC. Energetics and metabolic rate.In: Textbook of Medical Physiology, 8th ed. Philadelphia: WB Saunders Company, 1991: 789–96.Google Scholar
  8. 8.
    Veith RC, Best JD, Halter JB. Dose-dependent suppression of norepinephrine appearance rate in plasma by clonidine in man. J Clin Endocrinol Metab 1984; 59: 151–5.PubMedGoogle Scholar
  9. 9.
    Kooner JS, Birch R, Frankel HL, Peart WS, Mathias CJ. Hemodynamic and neurohormonal effects of clonidine in patients with preganglionic and postganglionic sympathetic lesions. Evidence for a central sympatholytic action. Circulation 1991; 84: 75–83.PubMedGoogle Scholar
  10. 10.
    Pouttu J, Tuominen M, Scheinin M, Rosenberg PH. Effects of oral clonidine premedication on concentrations of cortisol and monoamine neurotransmitters and their metabolites in cerebrospinal fluid and plasma. Acta Anaesthesiol Scand 1989; 33: 137–41.PubMedGoogle Scholar
  11. 11.
    Sessler DI, Schroeder M. Heat loss in humans covered with cotton hospital blankets. Anesth Analg 1993; 77: 73–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Segal IS, Jarvis DJ, Duncan SR, White PF, Maze M. Clinical efficacy of oral-transdermal clonidine combinations during the perioperative period. Anesthesiology 1991; 74: 220–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Takala J, Keinänen O, Väisänen P, Kari A. Measurement of gas exchange in intensive care: Laboratory and clinical validation of a new device. Crit Care Med 1989; 17: 1041–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosenberg IH. Nutrition and nutritional requirements.In: Harrison’s Principles of Internal Medicine, 13th ed. New York: McGraw-Hill, Inc., 1994: 437–40.Google Scholar
  15. 15.
    Ganong WF. Energy balance, metabolism, & nutrition. In: Review of Medical Physiology, 17th ed. Connecticut: Prentice-Hall International Inc., 1995: 255–89.Google Scholar
  16. 16.
    Davies DS, Wing LMH, Reid JL, Neill E, Tippett P, Dollery CT. Pharmacokinetics and concentration-effect relationships of intravenous and oral clonidine. Clin Pharmacol Ther 1977; 21: 593–601.PubMedGoogle Scholar
  17. 17.
    Reid JL. The clinical pharmacological of clonidine and related central antihypertensive agents. Br J Clin Pharmacol 1981; 12: 295–302.PubMedGoogle Scholar
  18. 18.
    Delaunay L, Bonnet F, Duvaldestin P. Clonidine decreases postoperative oxygen consumption in patients recovering from general anaesthesia. Br J Anaesth 1991; 67: 397–101.PubMedCrossRefGoogle Scholar
  19. 19.
    Delaunay L, Bonnet F, Liu N, Beydon L, Catoire P, Sessler DI. Clonidine comparably decreases the thermoregulatory thresholds for vasoconstriction and shivering in humans. Anesthesiology 1993; 79: 470–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Muraki T, Nakaki T, Kato R. Predominance of α2-adrenoceptors in porcine thyroid: biochemical and pharmacological correlations. Endocrinology 1984; 114: 1645–51.PubMedCrossRefGoogle Scholar
  21. 21.
    Melander A, Ranklev E, Sundler F, Westgren U. Beta2-adrenergic stimulation of thyroid hormone secretion. Endocrinology 1975; 97: 332–6.PubMedGoogle Scholar
  22. 22.
    Mertes N, Goeters C, Kuhmann M, Zander JF. Postoperative α2-adrenergic stimulation attenuates protein catabolism. Anesth Analg 1996; 82: 258–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Masala A, Satta G, Alagna S, et al. Effect of clonidine on stress-induced cortisol release in man during surgery. Pharmacological Research Communications 1985; 17: 293–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Grossman A, Weerasuriya K, Al-Damluji S, Turner P, Besser GM. Alpha2-adrenoceptor agonists stimulate growth hormone secretion but have no acute effects on plasma cortisol under basal conditions. Horm Res 1987; 25: 65–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Metz SA, Halter JB, Robertson RP. Induction of defective insulin secretion and impaired glucose tolerance by clonidine. Selective stimulation of metabolic alpha-adrenergic pathways. Diabetes 1978; 27: 554–62.PubMedGoogle Scholar
  26. 26.
    Joffe BI, Haitas B, Edelstein D, et al. Clonidine and the hormonal responses to graded exercise in healthy subjects. Horm Res 1986; 23: 136–41.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Hiroshi Takahashi
    • 1
  • Toshiaki Nishikawa
    • 1
  • Taro Mizutani
    • 1
  • Fumi Handa
    • 1
  1. 1.Department of Anaesthesiology, Institute of Clinical MedicineUniversity of TsukubaJapan

Personalised recommendations