Clonidine premedication was better in preventing hemodynamic response changes post laryngoscopy and endotracheal intubation compared to fentanyl premedication

Abstract

Background: Airway control under general anesthesia can be performed using laryngoscopy and endotracheal intubation. Laryngoscopy and endotracheal intubation produce mechanical and chemical stimuli that increase sympatho-adrenergic activity, causing an increased hemodynamic response. Various pharmacological and non-pharmacological methods have been used to reduce the response of hemodynamic changes in laryngoscopy and endotracheal intubation, such as fentanyl and clonidine. This study aimed to compare the effectiveness of fentanyl and clonidine in reducing hemodynamic response changes after laryngoscopy and endotracheal intubation. Methods: A double-blind randomized clinical trial was conducted on 48 elective surgery patients in the Surgical Installation of Dr. Kariadi General Hospital and Diponegoro National Hospital Semarang who were planned for laryngoscopy and endotracheal intubation procedures. Subjects were randomized and divided into 2 groups. Group 1 was administered with 2 µg/kgBW intravenous fentanyl premedication and group II was administered with 1 µg/kgBW intravenous clonidine premedication 5 minutes before the laryngoscopy and endotracheal intubation procedure. At baseline and at 1, 3, and 5 minutes after laryngoscopy and endotracheal intubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded simultaneously. Results: Both fentanyl and clonidine could maintain SBP, DBP, MAP, and HR within normal range. However, clonidine premedication seemed to be better in preventing hemodynamic response changes post-laryngoscopy and endotracheal intubation compared to fentanyl premedication. Clonidine premedication showed lower SBP, DBP, and MAP, but not HR, at the 1st and 3rd-minute post laryngoscopy and endotracheal intubation in comparison with fentanyl premedication (p<0.05). Conclusion: If confirmed by further findings, clonidine premedication may be preferable to prevent hemodynamic changes after laryngoscopy and endotracheal intubation.