Comparison of dexmedetomidine and clonidine for attenuation of sympathoadrenal responses and anesthetic requirements to laryngoscopy and endotracheal intubation

Authors

  • Shirsendu Mondal Department of Pharmacology, Medical College, Kolkata, West Bengal, India
  • Hindol Mondal Department of Pharmacology, Medical College, Kolkata, West Bengal, India
  • Ritaban Sarkar Department of Pharmacology, Medical College, Kolkata, West Bengal, India
  • Musfikur Rahaman Department of Pharmacology, Medical College, Kolkata, West Bengal, India

Keywords:

Clonidine, Dexmedetomidine, Anesthetic requirement, Hemodynamic response

Abstract

Background: Laryngoscopy and tracheal intubation after the induction of anesthesia are nearly always associated with a sympathetic hyperactivity. To attenuate the pressor response, various drugs have been tried, but studies to compare the effects of dexmedetomidine or clonidine on the hemodynamic response during laryngoscopy and tracheal intubation are anecdotal and sparse. This study aims to find the drug, which was best suited for this purpose and to compare their effects on sedation and anesthetic requirements.

Methods: This was a prospective study, which involved three groups of patients. Each group had 20 patients who presented for elective, non-cardiovascular surgeries. The patients in group I (control) were given normal saline and the groups II and III were given dexmedetomidine and clonidine, respectively. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and Ramsay sedation score were recorded at 1 and 2 min after completion of administration of study drug. Induction was done with propofol and required dose is noted. HR, SBP, and DBP were again assessed during intubation and at 1, 3, 5, and 10 min after intubation. The obtained clinical data were analyzed statistically with analysis of variance.

Results: In our study, HR, SBP, and DBP all increased during intubation and thereafter in all three groups. Pretreatment with dexmedetomidine 1 μg/kg and clonidine 2 μg/kg significantly attenuated the cardiovascular and catecholamine responses to tracheal intubation. However, attenuation was significantly more with the dexmedetomidine group with a quicker return to baseline. Dexmedetomidine also fared in terms of anesthetic requirement (propofol) and sedative action.

Conclusion: Preoperative administration of a single dose of dexmedetomidine blunted the hemodynamic responses more than clonidine or placebo during laryngoscopy, and reduced anesthetic requirements.

Metrics

Metrics Loading ...

References

Prys-Roberts C, Greene LT, Meloche R, Foëx P. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth. 1971;43(6):531-47.

Prys-Roberts C, Foëx P, Biro GP, Roberts JG. Studies of anaesthesia in relation to hypertension. V. Adrenergic beta-receptor blockade. Br J Anaesth. 1973;45(7):671-81.

Kale SC, Mahajan RP, Jayalakshami TS, Raghavan V, Das B. Nifedipine prevents the pressor response to laryngoscopy and tracheal intubation in patients with coronary artery disease. Anaesthesia. 1988;43(6):495-7.

Mikawa K, Nishina K, Maekawa N, Obara H. Comparison of nicardipine, diltiazem and verapamil for controlling the cardiovascular responses to tracheal intubation. Br J Anaesth. 1996;76(2):221-6.

Sun HL, Wu TJ, Ng CC, Chien CC, Huang CC, Chie WC. Efficacy of oropharyngeal lidocaine instillation on hemodynamic responses to orotracheal intubation. J Clin Anesth. 2009;21(2):103-7.

Aantaa R, Scheinin M. Alpha 2-adrenergic agents in anaesthesia. Acta Anaesthesiol Scand. 1993;37(5):433-48.

Quintin L, Bonnet F, Macquin I, Szekely B, Becquemin JP, Ghignone M. Aortic surgery: effect of clonidine on intraoperative catecholaminergic and circulatory stability. Acta Anaesthesiol Scand. 1990;34(2):132-7.

Virtanen R, Savola JM, Saano V, Nyman L. Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist. Eur J Pharmacol. 1988;150(1-2):9-14.

Scheinin H, Virtanen R, MacDonald E, Lammintausta R, Scheinin M. Medetomidine – a novel alpha 2-adrenoceptor agonist: a review of its pharmacodynamic effects. Prog Neuropsychopharmacol Biol Psychiatry. 1989;13(5):635-51.

Keith A, Sergio D, Paula M, Marc A, Wisemandle W, Alex Y. Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial. Anesth Analg. 2010;110:47-56.

Chraemmer-Jørgensen B, Hertel S, Strøm J, Høilund-Carlsen PF, Bjerre-Jepsen K. Catecholamine response to laryngoscopy and intubation. The influence of three different drug combinations commonly used for induction of anaesthesia. Anaesthesia. 1992;47(9):750-6.

Reid LC, Brace DE. Irritation of the respiratory tract and its reflex effect upon heart. Surg Gynecol Obstet. 1940;70:157-62.

Burstein CL, Lopinto FJ, Newman W. Electrocardiographic studies during endotracheal intubation. I. Effects during usual routine technics. Anesthesiology. 1950;11(2):224-37.

Roy S, Rudra A, Gupta K, Mondal T, Chakravorty S. Attenuation of cardiovascular response to laryngoscopy and tracheal intubation with oral clonidine (arkamine). Indian J Anaesth. 1993;41:62-5.

Bachofen M. Suppression of blood pressure increases during intubation: lidocaine or fentanyl?. Anaesthesist. 1988;37(3):156-61.

Zalunardo MP, Zollinger A, Spahn DR, Seifert B, Radjaipour M, Gautschi K, et al. Effects of intravenous and oral clonidine on hemodynamic and plasma-catecholamine response due to endotracheal intubation. J Clin Anesth. 1997;9(2):143-7.

Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth. 1992;68(2):126-31.

Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia. 1999;54(2):146-65.

Sağıroğlu AE, Celik M, Orhon Z, Yüzer S, Sen B. Dıfferent doses of dexmedetomidine on controlling haemodynamic responses to tracheal intubation. Internet J Anesthesiol. 2010;27:2.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011;55(4):352-7.

Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992;77(6):1134-42.

Derbyshire DR, Chmielewski A, Fell D, Vater M, Achola K, Smith G. Plasma catecholamine responses to tracheal intubation. Br J Anaesth. 1983;55(9):855-60.

Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987;59(3):295-9.

Yuen VM, Irwin MG, Hui TW, Yuen MK, Lee LH. A double-blind, crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine. Anesth Analg. 2007;105(2):374-80.

Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A, Otelcioglu S. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D. 2006;7(1):43-52.

Lee YY, Wong SM, Hung CT. Dexmedetomidine infusion as a supplement to isoflurane anaesthesia for vitreoretinal surgery. Br J Anaesth. 2007;98(4):477-83.

Downloads

Published

2017-01-24

How to Cite

Mondal, S., Mondal, H., Sarkar, R., & Rahaman, M. (2017). Comparison of dexmedetomidine and clonidine for attenuation of sympathoadrenal responses and anesthetic requirements to laryngoscopy and endotracheal intubation. International Journal of Basic & Clinical Pharmacology, 3(3), 501–506. Retrieved from https://www.ijbcp.com/index.php/ijbcp/article/view/1014

Issue

Section

Original Research Articles