A Prospective Randomized Study of Efficacy of Clonidine in Attenuating Haemodynamic Response to Laryngoscopy and Tracheal Intubation

Abstract

Background: Laryngoscopy and endotracheal intubation is often associated with hypertension and tachycardia because of sympatho-adrenal stimulation. In patients with cardiovascular and cerebrovascular disease, this sudden rise in heart rate and blood pressure can produce myocardial ischemia, pulmonary oedema and cerebral haemorrhage. Many drugs have been tried to blunt this hemodynamic response but none is ideal. Our aim was to study the efficacy of 3µg/kg clonidine intravenously, given 15 minutes before laryngoscopy and intubation in obtunding the hemodynamic response. Methods: One hundred patients were assigned randomly into two groups. Group I (n=50) received 10 ml of normal saline and group II (n=50) received injection Clonidine 3µg/kg diluted to 10 ml normal saline intravenously over 120 seconds, 15 minutes prior to laryngoscopy and intubation. After premedication anaesthesia was induced with thiopentone till loss of eye lash reflex and dose of thiopentone required was recorded. HR, SBP, DBP and MAP were recorded at various time intervals before and after intubation. Results: In group I, following laryngoscopy and intubation, the rise in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were found to be more compared to group II which was statistically significant (p<0.01).In addition Clonidine reduced the requirement of thiopentone and produced arousable sedation after extubation without any side effects like bradycardia and hypotension. Conclusion: Clonidine in the dose of 3µg/kg body weight given intravenously 15 minutes before laryngoscopy and intubation was seen to effectively attenuate the hemodynamic response to laryngoscopy and intubation without any side effects.

Intravenous Clonidine with Lignocaine Nebulization to Attenuate the Hemodynamic Response to Laryngoscopy and Tracheal Intubation: A Comparative Study

“…13 Contrary to the above findings, Acharya and Routray and Marulasiddappa and Nethra noticed that no side effects, such as hypotension and bradycardia, were observed in any of the patients when clonidine was given in the dose of 3 and 2 µg per kg, respectively. 25,14 Acharya and Routray and Chhatrapati and Shitole found that clonidine in a dose of 3 µg per kg caused adequate sedation without respiratory depression, whereas in our study, sedation was not seen in any patient. 25,26 conclusIon To conclude, i.v.…”

“…25,14 Acharya and Routray and Chhatrapati and Shitole found that clonidine in a dose of 3 µg per kg caused adequate sedation without respiratory depression, whereas in our study, sedation was not seen in any patient. 25,26 conclusIon To conclude, i.v. clonidine in a dose of 1 µg per kg administered 15 minutes before laryngoscopy and intubation was far superior to nebulized lignocaine alone in attenuation of the hemodynamic response.…”