Year of Publication

2017

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Wayne Sanderson, MS, CIH, PhD

Committee Member

Steve Browning, MSPH, PhD

Committee Member

Steven Fleming, PhD

Abstract

Background:

Clonidine is an alpha-2 adrenergic agonist which has been used to treat hypertension for over 40 years. In October 2008, clonidine was approved by the FDA for use as a premedication agent prior to sedation. The overall goal of this study is to determine if clonidine can be used as a pre- operative sedative agent in moderate sedation dentistry and if so, what should be considered a safe level.

The following specific aims were established for this study:

  1. To determine whether patients receiving clonidine required less intravenous medications.
  2. To determine if clonidine can lower blood pressure and pulse to a safe level (allowing adequate perfusion).
  3. To assess whether larger doses of oral clonidine 0.2 mg are significantly different in lowering blood pressure and pulse from lower doses of 0.1 mg.

Methods:

This study was a clinical, cross sectional study of patients in a major inner city dental clinic that provides free dental care to patients in financial need. Data were collected from treatment records completed from March 2012-April 2012. The associations between study sample characteristics and use of clonidine at two dose levels (0.1 mg and 0.2 mg vs. controls) were examined. An analysis of variance was undertaken with the Duncan’s, Multiple Range Test for comparison of the hemodynamic changes (e.g. systolic, diastolic, mean arterial pressure, and pulse) of patients taking clonidine 0.1 mg, clonidine 0.2mg, and the control group.

Results:

At pre-sedation, the clonidine 0.2 mg group had lower systolic and diastolic blood pressures than the 0.1 mg group and the control group. During first intraoperative period, the results show the mean systolic blood pressure of 0.2 group was significantly lower than the control group. After adjustment for age, BMI, and dose of Versed administered, mean systolic blood pressures for the 0.2 mg clonidine dose group were significantly lower at pre- sedation and the first intraoperative times in comparison to the 0.1 mg group and the controls. Diastolic blood pressures were not different by the three groups after adjustment in the model. The use of clonidine at both dose groups did not significantly change the amount of sedation medication required, although the data did suggest more sedatives were required at lower clonidine doses.

Conclusion:

This study did not find that the use of clonidine led to a significant reduction in the amount of sedation medication needed. The mean systolic blood pressures for the 0.2 mg clonidine dose group were significantly lower at pre- sedation and the first intraoperative times in comparison to the 0.1 mg group and the controls in the adjusted model; however, there were no significant differences across the measurement times for the effect of clonidine on diastolic blood pressure. Further research with a more robust sample size in the dose groups and improved clinical trial design characteristics would improve our assessment of the effectiveness of the use of clonidine in sedation dentistry.

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