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A Comparative Clinical Study of Oral Clonidine Versus Intravenous Clonidine on Haemodynamic Changes due to Laryngoscopy and Endotracheal Intubation

Received: 18 December 2019     Accepted: 30 December 2019     Published: 8 January 2020
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Abstract

Laryngoscopy with or without endotracheal intubation amounts to a highly noxious stimulus to the haemodynamics of a patient and various efforts have been made to attenuate this response. This study was conducted to compare the effects of oral Clonidine and IV Clonidine premedication on haemodynamic response to laryngoscopy and endotracheal intubation. This is a prospective, randomized controlled, double blind study conducted after obtaining institutional ethical approval. One hundred normotensive patients between 18-45yrs of age (ASA Grade I & II) scheduled for elective surgery were sub-divided into two groups with 50 patients in each group. Oral or intravenous clonidine 3μg/kg was given at 30 and 15 minutes before induction. Patients were Induced with inj Propofol 2.5 mg/kg, fentanyl 1μg kg-1 and inj Vecuronium 0.12mg/kg and intubated. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rate pressure product (RPP) were recorded at Basal (before administration of study drug), pre laryngoscopy (after administration of study drug but before induction of anaesthesia) and post laryngoscopy at 1, 3, 5, 10 and 15 minutes respectively. HR, SBP, DBP, and RPP decreased by -3.6%, -9.5%, - 11.5%, -12.7% in the oral clonidine group and by -3.4%, -16.3%, -11.9%, -19.1% in IV clonidine group from basal to pre laryngoscopy values (p<0.05). An increase was seen in both the group at 1, 3 and 5 minutes after intubation in both the groups. But the response was significantly less in the IV Clonidine group as compared to the Oral group. All the variables returned towards baseline values by 10-15 minutes post-laryngoscopy in either group. Oral Clonidine 3μ/kg was less effective than IV Clonidine 3μg/kg in blunting haemodynamic stress response. IV Clonidine premedication effectively blunted stress response to endotracheal intubation in ASA physical status I and II patients without causing adverse reactions.

Published in Pharmaceutical Science and Technology (Volume 3, Issue 2)
DOI 10.11648/j.pst.20190302.11
Page(s) 34-39
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Attenuation, Clonidine, Haemodynamic, Intubation, Laryngoscopy

References
[1] Singh, S., Laing, E. F., Ansah-Owiredu, W. K. B., Singh, A., and Annamalai, A. (2013). A study of the efficacy of cardiac antidysrhythmic drugs in attenuating haemodynamic responses to laryngoscopy and endotracheal intubation in the black population. J Anesthe Clinic Res, 4: 326-32.
[2] Manjunath, H. G., Venkatesh, G. S., Prima, V., Jennifer, L. V., and Sathees, B. C. (2008). Can calcium and sodium channel blockers attenuate hemodynamic responses to endotracheal intubation? Eur J Gen Med, 5: 198-207.
[3] Kaygusuz, K., Toker, M. I., Kol, I. O., Erdogan, H., Gursoy, S., and Mimaroglu, C. (2007). The effects of different doses of remifentanil on intraocular pressure after tracheal intuba-tion: a randomized, double-blind and pro-spective study. Ann Ophthalmol (Skokie), 39: 198-204.
[4] Bostana, H., and Eroglu, A. (2012). Comparison of the clinical efficacies of fentanyl, esmolol and lidocaine in preventing the hemody-namic responses to endotracheal intubation and extubation. Journal of Current Surgery, 2: 24-28.
[5] Moon, Y. E., Lee, S. H., and Lee, J. (2012). The optimal dose of esmolol and nicardipine for mantaining cardiovascular stability during rapid sequence induction. Journal of Clinical Anaesthesia, 24: 8-13.
[6] Singh, S., Laing, E. F., Ansah-Owiredu, W. K. B., and Singh, A. (2012). Attenuation of cardiovascular response by ß-blocker esmolol during laryngoscopy and intubation. Journal of Medical and Biomedical Sciences, 1 (4): 27-33.
[7] Stoelting, R. K. (1978). Blood Pressure and heart rate changes during short duration laryngoscopy for tracheal intubation: Influence of viscous or intravenous lidocaine. Anesth Analg, 57: 197-99.
[8] Annamalai, A., Singh, S., Singh, A., and Mahrous, D. E. (2013). Can intravenous dexmedetomidine prolong bupivacaine intrathecal spinal anesthesia? J Anesth Clin Res, 4: 372-77.
[9] Ali, N. P., Kanchi, M., Singh, S., Prasad, A., and Kanase, N. (2014). Dexmedetomedine-ketamine versus propofol-ketamine as anaesthetic agents in paediatric cardiac catheterization. JAFMC Bangladesh, 10 (1); 19-24.
[10] Singh, S., Kulsum, Shroff, H., Singh, S., Annamalai, A., and Mahrous, D. E. (2013). Can sodium channel blocker lidocaine attenuate haemodynamic responses to endotracheal intubation in patients with coronary artery disease effectively? Journal of Anesthesiology, 1 (3): 27-35.
[11] Singh, S., Laing, E. F., Ansah-Owiredu W. K. B., and Singh, A. (2013). Comparison of esmolol and lidocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation in a Ghanaian population. Anesth Essays Res, 7: 83-8.
[12] Allam, J., Sheikh, M. M., and Ara, R. (2018). Effect of oral clonidine on hemodynamic changes due to laryngoscopy, intubation and operative procedures stress response. Arch Phar & Pharmacol Res, 1 (3). DOI: 10.33552/APPR.2018.01.000512.
[13] Carabine, U. A., Wright, P. M. C., and Moore, J. (1991). Preanaesthetic medication with Clonidine: A dose response study. Br J Anaesth, 67: 79-83.
[14] Kulka, P. J., Tryba, M., and Zenz, M. (1995) Dose response effects of intravenous clonidine on stress response during induction of anaesthesia in CABG patients. Anaesthesia & Analgesia, 80 (2): 263-268.
[15] Lambert, P., Cyna, A. M., Knight, N., and Middleton, P. (2014). Clonidine premedication for postoperative analgesia in children. Cochrane Database of Systematic Reviews 1, doi.org/10.1002/14651858.CD009633.
[16] Raval, D. L., and Mehta, M. K. (2002). Oral clonidine premedication for attenuation of hemodynamic response to laryngoscopy and intubation. Indian J Anaesth, 46 (2): 124 29.
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  • APA Style

    Sanjeev Singh. (2020). A Comparative Clinical Study of Oral Clonidine Versus Intravenous Clonidine on Haemodynamic Changes due to Laryngoscopy and Endotracheal Intubation. Pharmaceutical Science and Technology, 3(2), 34-39. https://doi.org/10.11648/j.pst.20190302.11

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    ACS Style

    Sanjeev Singh. A Comparative Clinical Study of Oral Clonidine Versus Intravenous Clonidine on Haemodynamic Changes due to Laryngoscopy and Endotracheal Intubation. Pharm. Sci. Technol. 2020, 3(2), 34-39. doi: 10.11648/j.pst.20190302.11

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    AMA Style

    Sanjeev Singh. A Comparative Clinical Study of Oral Clonidine Versus Intravenous Clonidine on Haemodynamic Changes due to Laryngoscopy and Endotracheal Intubation. Pharm Sci Technol. 2020;3(2):34-39. doi: 10.11648/j.pst.20190302.11

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  • @article{10.11648/j.pst.20190302.11,
      author = {Sanjeev Singh},
      title = {A Comparative Clinical Study of Oral Clonidine Versus Intravenous Clonidine on Haemodynamic Changes due to Laryngoscopy and Endotracheal Intubation},
      journal = {Pharmaceutical Science and Technology},
      volume = {3},
      number = {2},
      pages = {34-39},
      doi = {10.11648/j.pst.20190302.11},
      url = {https://doi.org/10.11648/j.pst.20190302.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.pst.20190302.11},
      abstract = {Laryngoscopy with or without endotracheal intubation amounts to a highly noxious stimulus to the haemodynamics of a patient and various efforts have been made to attenuate this response. This study was conducted to compare the effects of oral Clonidine and IV Clonidine premedication on haemodynamic response to laryngoscopy and endotracheal intubation. This is a prospective, randomized controlled, double blind study conducted after obtaining institutional ethical approval. One hundred normotensive patients between 18-45yrs of age (ASA Grade I & II) scheduled for elective surgery were sub-divided into two groups with 50 patients in each group. Oral or intravenous clonidine 3μg/kg was given at 30 and 15 minutes before induction. Patients were Induced with inj Propofol 2.5 mg/kg, fentanyl 1μg kg-1 and inj Vecuronium 0.12mg/kg and intubated. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rate pressure product (RPP) were recorded at Basal (before administration of study drug), pre laryngoscopy (after administration of study drug but before induction of anaesthesia) and post laryngoscopy at 1, 3, 5, 10 and 15 minutes respectively. HR, SBP, DBP, and RPP decreased by -3.6%, -9.5%, - 11.5%, -12.7% in the oral clonidine group and by -3.4%, -16.3%, -11.9%, -19.1% in IV clonidine group from basal to pre laryngoscopy values (p<0.05). An increase was seen in both the group at 1, 3 and 5 minutes after intubation in both the groups. But the response was significantly less in the IV Clonidine group as compared to the Oral group. All the variables returned towards baseline values by 10-15 minutes post-laryngoscopy in either group. Oral Clonidine 3μ/kg was less effective than IV Clonidine 3μg/kg in blunting haemodynamic stress response. IV Clonidine premedication effectively blunted stress response to endotracheal intubation in ASA physical status I and II patients without causing adverse reactions.},
     year = {2020}
    }
    

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    AB  - Laryngoscopy with or without endotracheal intubation amounts to a highly noxious stimulus to the haemodynamics of a patient and various efforts have been made to attenuate this response. This study was conducted to compare the effects of oral Clonidine and IV Clonidine premedication on haemodynamic response to laryngoscopy and endotracheal intubation. This is a prospective, randomized controlled, double blind study conducted after obtaining institutional ethical approval. One hundred normotensive patients between 18-45yrs of age (ASA Grade I & II) scheduled for elective surgery were sub-divided into two groups with 50 patients in each group. Oral or intravenous clonidine 3μg/kg was given at 30 and 15 minutes before induction. Patients were Induced with inj Propofol 2.5 mg/kg, fentanyl 1μg kg-1 and inj Vecuronium 0.12mg/kg and intubated. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rate pressure product (RPP) were recorded at Basal (before administration of study drug), pre laryngoscopy (after administration of study drug but before induction of anaesthesia) and post laryngoscopy at 1, 3, 5, 10 and 15 minutes respectively. HR, SBP, DBP, and RPP decreased by -3.6%, -9.5%, - 11.5%, -12.7% in the oral clonidine group and by -3.4%, -16.3%, -11.9%, -19.1% in IV clonidine group from basal to pre laryngoscopy values (p<0.05). An increase was seen in both the group at 1, 3 and 5 minutes after intubation in both the groups. But the response was significantly less in the IV Clonidine group as compared to the Oral group. All the variables returned towards baseline values by 10-15 minutes post-laryngoscopy in either group. Oral Clonidine 3μ/kg was less effective than IV Clonidine 3μg/kg in blunting haemodynamic stress response. IV Clonidine premedication effectively blunted stress response to endotracheal intubation in ASA physical status I and II patients without causing adverse reactions.
    VL  - 3
    IS  - 2
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Author Information
  • Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

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