Oral Clonidine vs Oral Pregabalin Premedication to Attenuate Pressor Response to Direct Laryngoscopy in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Double Blind Study.

Abstract

Direct laryngoscopy and tracheal intubation has adverse effects like tachycardia, hypertension, myocardial ischemia and cerebral haemorrhage. There are several studies on various pharmacological agents to attenuate this response. This study was designed to compare efficacy and safety of oral clonidine and oral pregabalin premedication to attenuate stress response in patients undergoing laparoscopic cholecystectomy. Total 80 patients of ASA grade I and II, aged between 20-60 years of both sexes scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients were randomized into two groups. Group A received oral clonidine 0.3mg and group B received oral pregabalin 150mg, 60 minutes before surgery. Anaesthesia technique was standardized. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), mean arterial pressure (MAP) and heart rate were recorded preoperatively, after premedication, immediately after intubation, then at 1 min, 3 min, 5 min, 10 min and 15 min after intubation. Level of sedation, postoperative pain scores and any adverse effects were also noted and compared. Oral clonidine 0.3mg as well as oral pregabalin 150mg were effective in blunting haemodynamic stress response to laryngoscopy and tracheal intubation. Clonidine was found to be better than pregabalin in lowering of systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate changes associated with laryngoscopy. We also found that bradycardia was common with both the drugs, more so in clonidine group. Post-operative analgesia was better in pregabalin group as compared to clonidine group. Both the drugs cause sedation, but it was more with the use of pregabalin. Both the drugs can be used as an effective premedicant to attenuate the sympathetic response to laryngoscopy and tracheal intubation without much side effects and the added advantage of intraoperative and postoperative analgesia.