Abstract
Laryngoscopy with or without endotracheal intubation amounts to a highly noxious stimulus to the haemodynamics of a patient and various efforts have been made to attenuate this response. This study was conducted to compare the effects of oral Clonidine and IV Clonidine premedication on haemodynamic response to laryngoscopy and endotracheal intubation. This is a prospective, randomized controlled, double blind study conducted after obtaining institutional ethical approval. One hundred normotensive patients between 18-45yrs of age (ASA Grade I & II) scheduled for elective surgery were sub-divided into two groups with 50 patients in each group. Oral or intravenous clonidine 3μg/kg was given at 30 and 15 minutes before induction. Patients were Induced with inj Propofol 2.5 mg/kg, fentanyl 1μg kg<sup>-1</sup> and inj Vecuronium 0.12mg/kg and intubated. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rate pressure product (RPP) were recorded at Basal (before administration of study drug), pre laryngoscopy (after administration of study drug but before induction of anaesthesia) and post laryngoscopy at 1, 3, 5, 10 and 15 minutes respectively. HR, SBP, DBP, and RPP decreased by -3.6%, -9.5%, - 11.5%, -12.7% in the oral clonidine group and by -3.4%, -16.3%, -11.9%, -19.1% in IV clonidine group from basal to pre laryngoscopy values (p<0.05). An increase was seen in both the group at 1, 3 and 5 minutes after intubation in both the groups. But the response was significantly less in the IV Clonidine group as compared to the Oral group. All the variables returned towards baseline values by 10-15 minutes post-laryngoscopy in either group. Oral Clonidine 3μ/kg was less effective than IV Clonidine 3μg/kg in blunting haemodynamic stress response. IV Clonidine premedication effectively blunted stress response to endotracheal intubation in ASA physical status I and II patients without causing adverse reactions.
Highlights
Laryngoscopy and tracheal intubation are the most essential tools of an anaesthesiologist in airway management
Basal heart rate (HR) before receiving clonidine was 82.78±6.47 and 83.10±7.53 in the oral and IV clonidine groups, which is statistically insignificant with P-value > 0.05
HR was well controlled in the IV group as compared to oral clonidine group
Summary
Laryngoscopy and tracheal intubation are the most essential tools of an anaesthesiologist in airway management. Endotracheal intubation has been practised routinely and it is a well-known fact that laryngoscopy induces a cardiovascular stress response characterised by hypertension and tachycardia due to reflex sympathetic stimulation [1]. This increase in blood pressure and heart rate are usually transitory variable and unpredictable lasting for a few minutes. Several attempts have been made to attenuate haemodynamic changes which include an increase in blood pressure and heart rate in response to laryngoscopy and endotracheal intubation. Pharmacological approaches involving the use of lidocaine (Manjunath et al, 2008) [2], remifentanil (Kaygusuz et al, 2007) [3], fentanyl (Bostana and Eroglu, 2012) [4], a combination of esmolol and nicardipine
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