Effect of oral clonidine premedication on attenuating haemodynamic response to laryngoscopy and intubation during general anaesthesia
Keywords:Oral clonidine, Laryngoscopy and endotracheal intubation, Attenuation of haemodynamic response, HR, SBP, DBP, MAP
Background: Laryngoscopy with or without tracheal intubation evokes a defense mechanism that in turn alters patients’ haemodynamic responses in terms of increased heart rate (HR) and arterial blood pressure (ABP). Aim of current investigation was to study the efficacy of orally administered clonidine in a dose of 3-3.5 µg/kg given 90 minutes prior to scheduled time of the surgery, in attenuating the adverse haemodynamic responses to laryngoscopy and intubation of the trachea.
Methods: Eighty normotensive patients between 20-60 years of age and having ASA grade I/II physical status were subdivided in two groups with 40 patients in each; test group received clonidine in a dose of 3-3.5 mcg/kg of body weight orally, 90 min before surgery and control group did not receive clonidine premedication. Induction was done with Thiopentone intravenous injection (5 mg/kg), followed by succinylcholine (1-1.5 mg/kg).
Results: Haemodynamic responses in terms of parameters like HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were recorded at pre induction and at 1, 2, 3, 5 minutes following laryngoscopy. The 1-minute post induction values of SBP, DBP, MAP were significantly less in clonidine group (p<0.001) and the significance in listed parameters between two groups persisted until 5 minutes. Increase in HR was less in clonidine group than in control group.
Conclusions: Premedication with oral clonidine 3-3.5 mcg/kg of body weight, 90 minutes before laryngoscopy and intubation is an efficient, simple and inexpensive method in attenuating the haemodynamic response generated due to laryngoscopy and intubation.
Andrade RGADC, Lima BLS, Lopes DKO, Couceiro RO, Lima LC, Couceiro TCM. Difficult laryngoscopy and tracheal intubation: observational study. Braz J Anesthesiol. 2018;68(2):168-73.
Rajan S, Chandramohan R, Paul J, Kumar L. Hemodynamic response to tracheal intubation in postlaryngectomy patients. J Anaesthesiol Clin Pharmacol. 2019;35(4):504-8.
King BD, Harris LC, Greifenstein FE, Elder JD, Dripps RD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology. 1951;12(5):556-66.
Safavi M, Honarmand A. Attenuation of cardiovascular responses to laryngoscopy and tracheal intubation-intravenous sufentanil vs. pethidine. Middle East J Anaesthesiol. 2008;19(6):1349-59.
Yoo KY, Jeong CW, Kim SJ, Jeong ST, Shin MH, Lee J. Cardiovascular and arousal responses to laryngoscopy and tracheal intubation in patients with complete spinal cord injury. Br J Anaesth. 2009;102(1):69-75.
Stoelting RK. circulatory changes during direct laryngoscopy and intubation. Anesthesiology. 1977;47:381-4.
Devault M, Greifenstein FE. Circulatory responses to endotracheal intubation in light general anaesthesia. Anaesthesiology. 1960; 21(4):360-2.
Sarkar A, Tripathi RK, Choubey S, Singh RB, Awasthi S. Comparison of effects of intravenous clonidine and dexmedetomidine for blunting pressor response during laryngoscopy and tracheal intubation: A randomized control study. Anesth Essays Res. 2014;8(3):361-6.
Soltani MS, Maziar A, Saliminia A. Comparing clonidine and lidocaine on attenuation of hemodynamic responses to laryngoscopy and tracheal intubation in controlled hypertensive patients: a randomized, double-blinded clinical trial. Anesth Pain Med. 2016;6(2):e34271.
Sharma V, Fotedar K, Goel R. Comparison of Oral Clonidine and Gabapentin Premedication for Attenuation of Pressor Response to Laryngoscopy and Endotracheal Intubation. Anesth Essays Res. 2020;14(3):412-419.
Dollery CT, Davis DS. Clinical pharmacology and pharmacokinetics of clonidine. Clin Pharmacol Therap. 1976;19:11
Bruder N, Ortega D, Granthil C. Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation. Ann Fr Anesth Reanim. 1992;11(1):57-71.
Wycoff C. Endotracheal intubation; effects on blood pressure and pulse rate. Anesthesiology. 1960;21(2):153-7.
Derbyshire A, Smith G. Plasma catecholamine response lo tracheal intubation. British J Anaesth. 1983; 55:855-9.
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.
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.
Michael M, Goff DR. Clonidine reduces sympathetic activity but maintains baroreflex responses in normotensive humans. Anaesthesiology. 1992;77:864:71.
Raval D, Mehta MK. Oral clonidine premedication for attenuation of haemodynamic response to laryngoscopy and intubation. Indian J Anaesth. 2002;46(2):124-9.
Rudra R, Das AK. Clinical efficacy of oral clonidine as a preanaesthetic medicant. Indian J Anaesth. 1995;43:133-9.