Online ISSN: 2515-8260

Keywords : pressor response

A Comparative Study of Oral Clonidine and Intravenous Fentanyl in Attenuation of The Hemodynamic Responses to Laryngoscopy and Endotracheal Intubation inaTertiaryCare Hospital

Pawan Kumar Singh, Vaishnavi Kulkarni, Mangesh Khadse, Swapnali Swami

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 4, Pages 199-210

In anaesthesia, circulatory stimulation during tracheal intubation are caused by the stimulation of laryngeal and tracheal tissues from both direct laryngoscopy and placement of the ET tube in the trachea. These stimuli often evoke sympathoadrenal responses characterized by changes in Blood pressure, Heart rate, Cardiac rhythm, ST segment changes, and may lead to pulmonary oedema and rupture of cerebral aneurysm. In the present study that was carried out in the Institute, we compared the efficacy of Oral Clonidine versus Intravenous Fentanylin attenuating the cardiovascular stress response to laryngoscopy and tracheal intubation.
Material and Methods: The present Prospective and Comparative study was carried out at a Tertiary Care Hospital amongst 100 patients those who were randomly allocated to two groups, Group C: Patients in this group received- 5 microgram/kg of Oral Clonidine with 2 sips of water 90 minutes prior to surgery. Group F: Patients in this group received 100ml of normal saline over 10 minutes and 2 microgram /kg of fentanyl in 5ml of normal saline, 5 minutes prior to laryngoscopy and intubation.
Results: Out of 100 subjects, 32% subjects were in the age group 21 to 30 years and 22% in 41 to 50 years. The mean heart rate during Laryngoscopy in the groups Fentanyl and Clonidine were 108.58 and 91.56 respectively. The mean SBP during Laryngoscopy in the groups Fentanyl and Clonidine was 139.84 and 124.78 respectively and the mean SBP at 1 minute after intubation was 137.14 and 121.94 respectively. The mean DBP during laryngoscopy in the groups Fentanyl and Clonidine were 91.18 and 82.68. and at 1 minute after intubation, it was 88.36 and 78.52 respectively. The mean MAP at 1 minute after intubation in the groups Fentanyl and Clonidine were 101.54 and 92.98 respectively
Conclusion: Oral Clonidine 5 μg/kg proved to keep the hemodynamics in stable manner during laryngoscopy and endotracheal intubation and up to 30 mins post-intubation. Fentanyl in the dosage of 2 μg /kg given 5 minutes before laryngoscopy and intubation attenuated the hemodynamic changes, but was not equally effective in reducing the increase in heart rate and blood pressure.  

Effect of oral clonidine as premedication for anxiety and attenuation of pressor response during laryngoscopy and intubation undergoing laparoscopic cholecystectomy

Dr. Aruna Sharma, Dr. Dipankar Singh, Dr. RS Thakur, Dr. Smriti Anand, Dr. Rakesh Sadhu, Dr. Sachin K Gupta, Dr. Kanika, Dr. Gaurav

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 3, Pages 811-820

Surgery is an event that causes anxiety among the majority of patients. In addition, laryngoscopy and intubation cause disturbance in the heart rate and blood pressure rhythm. Together preoperative anxiety and intubation can prove harmful for some patients.
Aim: To observe the clinical effects of Clonidine on anxiety & cardiovascular parameters (pressor response) during direct laryngoscopy and tracheal intubation.
Material and Methods: A single-centre, parallel-group, two-arm, 1:1, double-blind, placebo-controlled, randomised, intervention study. A total of 100 participants: 50 in the clonidine group and 50 in the placebo group were enrolled in the present study. Participants in the clonidine group were given oral clonidine at a dose of 200 micrograms 90 minutes before induction.
Results: The increase in heart rate and mean arterial blood pressure was significantly less among patients given clonidine in comparison to placebo. In addition, participants given Clonidine showed fewer fluctuations in their heart rate and blood pressure throughout the surgery. Participants given Clonidine were more less anxious before surgery in comparison to those given the placebo. None of the participants given Clonidine had any adverse effect.
Conclusion: Clonidine is effective at attenuating the haemodynamic response to laryngoscopy and intubation. In addition, Clonidine has an anxiolytic action.

To study the effects of low dose oral clonidine premedication in attenuating the haemodynamic response to laryngoscopy and intubation

Dr.Pavankumar P, Dr.Venugopal K, Dr.Vinuth K Murthy

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2850-2857

Background: The induction of anesthesia, laryngoscopy, tracheal intubation and surgical
stimulation often evoke cardiovascular responses characterized by alteration in systemic
arterial blood pressure, heart rate and cardiac rhythm
Aim: Efficacy of low dose of clonidine in attenuating the haemodynamic response to
intubation. Comparing two doses of oral clonidine in attenuating haemodynamic response to
Materials and Methods: The study will be conducted on 60 patients who will be undergoing
elective surgery under general anesthesia during the period of 2017 to 2019.
Group CL-1 and Group CL-2 patients were premeditated with oral Clonidine 60 minutes
prior to the surgery.
Randomisation: All the patients included in the study were randomized into 3 groups,
Group CL-1: Patients who received oral Clonidine premedication at the dose of 1 microgram
per kg.
Group CL-2: Patients who received clonidine premedication at the dose of 2microgram per
Group CS: Patients who received premedication with oral saline.
After shifting the patient inside the operating room noninvasive blood pressure, saturation
probe and electrocardiogram monitoring with 5 leads were attached and baseline values were
Duration of laryngoscopy and intubation (from the time laryngoscope inserted till the end
tidal CO2 is seen on the monitor) was noted, grade of laryngoscopy, heart rate, systolic
diastolic and mean blood pressures are noted at the time of induction, just before
laryngoscopy, immediately after intubation and 1,3 and 5mins after intubation by investigator
Results: In the present study when we evaluated the heart rate,SBP,DBP,MAP. There was
least variation HR, SBP, DBP and MAP, in those who received 2 mg clonidine as those who
received 1 mg clonidine as compared to the placebo saline group