A study on oral clonidine vis a vis intravenous lignocaine for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation (original) (raw)
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Iris Publishers LLC, 2018
Context: Endotracheal intubation constitutes a period of extreme hemodynamic stress. Clonidine, α2 adrenergic agonist, slows down the heart rate and leads to a dose‑dependent decrease in systolic and diastolic blood pressure. It has 100% bioavailability following oral administration. Aims: Effect of oral clonidine on hemodynamic changes due to laryngoscopy, intubation and operative procedures stress response. Setting and design: This was a prospective, randomized controlled, double‑blind study. Materials and methods: Fifty patients of either sex, aged 18‑45 years, ASA grade I/II undergoing elective surgeries under general anaesthesia were included. Group A received Clonidine 4 mcg/kg orally induction and group B received 5 ml distilled water. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure, and rate pressure product were noted at baseline, reinduction, postinduction, intubation and thereafter, 1, 3,5,10,15,20,25 and 30min following intubation. Results: There was a statistically significant difference in heart rate, systolic, diastolic, mean arterial pressure and rate pressure product between two groups. Clonidine group had more stable hemodynamic parameters throughout. Conclusion: Oral clonidine premedication in the dose of 4 mcg/kg can effectively attenuate the hemodynamic stress response during laryngoscopy, intubation and operative procedures.
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Laryngoscopy and endotracheal intubation are noxious stimuli capable of producing tachycardia, arrhythmias and hypertension. This study was being done to compare the effectiveness of a pre-induction dose of clonidine with dexmedetomidine administered by intravenous infusion inattenuating the haemodynamic stress responses resulting from laryngoscopy and endotracheal intubation. Materials and Methods: Sixty adult patients included in this study were randomly divided into two groups, namely, Group A (Clonidine 4 mcg/kg) & Group B (Dexmedetomidine 1 mcg/kg) using computer generated random allocation chart and haemodynamic parameters were analyzed and recorded quantitatively from preoperative period to 30 mins post – intubation period. In the immediate post operative period and 2 hours after surgery, patient’s recovery was assessed with ALDRETE recovery score and BRUSSEL’S sedation score. Results: Mean heart rate showed fall following dexmedetomidine or clonidine infusion (19% and 23% respectively from the baseline) which was clinically significant in clonidine group but was statistically not significant in both the groups (p>0.05), while the increase in Mean heart rate following intubation was 8% and 10% respectively. In the current study, there was fall in blood pressure following infusion of study drug which was clinically not significant.Following tracheal intubation, maximal average increase was 5% in systolic and 3% in diastolic blood pressure in dexmedetomidine group, as compared to clonidine group in which, it was 6% and 4%, respectively. Isoflurane consumption, propofol requirement and opioid requirement throughout the intraoperative period was reduced in both the Groups. Aldrete recovery score and Brussels sedation score were calculated and found better in group B as compared to group A. Patients were sedated but arousable. Conclusion: Based on our study we conclude that both clonidine and dexmedetomidine are equally effective in attenuating the pressor response caused by laryngoscopy and tracheal intubation. Keywords: Dexmedetomidine, Clonidine, Laryngoscopy, Aldrete score, Brussels score.
Background: The stress response to laryngoscopy and endotracheal intubation is a commonly encountered physiological phenomenon. Though the response can be transient and harmless in normotensive healthy patients, but it may prove hazardous amongst patient with underlying cardiac disease, or hypertensive disease and its sequelae. Present study was planned to evaluate the efficacy of IV dexmedetomidine infusion and IV lignocaine in attenuating the hemodynamic responses during laryngoscopy and intubation. Methodology: On approval from hospital ethical committee, 120 ASA grade I and II, normotensive patients in the age group of 18-60 years, planned for elective surgery under general anesthesia were enrolled in the study. Patients were divided into 3 equal groups of 40 each; Group A (Lignocaine group) received lignocaine 1.5 mg/kg IV 2 min before induction, Group B (dexmedetomidine group) received dexmedetomidine 1 µ/kg IV infusion with syringe pump 10 min before induction, and Group C (control group) received normal saline before induction. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation of arterial blood (SpO2) and electrocardiogram (ECG) were monitored at induction, intubation and post intubation at one minute interval till 10th minute. Results: A better control of stress response was observed in patients receiving dexmedetomidine infusion. More decrease in HR was noted in Group B as compared to Group A (9.28 % vs. 13.40%) respectively. The decrease in MAP was also more in Group B as compared to group receiving lignocaine (5.49 % vs. 10.72%) respectively. Conclusion: Dexmedetomidine 1 µg/kg IV is more effective in blunting stress response to laryngoscopy and endotracheal intubation as compared to lignocaine 1.5 mg/kg IV.
2015
Background: Laryngoscopy and tracheal intubation induce potentially harmful hemodynamic response. None of the advocated methods had been accepted as the most effective option. Ease of use and economical advantages of the suggested methods are also important considerations. This study was designed to address this concern by using two common drugs (intravenous lignocaine vs.oral clonidine). Material and Method: A randomized, controlled, prospective, single blind study was planned involving 70 patients divided equally into two groups-Group C (patients received oral Clonidine 4 mcg/kg 90 minutes prior to intubation) and Group L (Patients received intravenous Lignocaine 2 mg/kg 3 minutes prior to intubation). Observations: Focus was on hemodynamic parameters-Heart rate, Systolic, Diastolic, Mean blood pressures and Rate pressure product, however, sedation and anxiety score was also compared. Results: Demographic profile and time taken for intubation was same in both the groups. Post intubation rise (>25 % from base line) in heart rate was observed more in Gr.L (54.28 %) as compared to 5.71 % in Gr.C. Systolic, diastolic and mean arterial blood pressure variations were observed more in Gr L (42.85 %, 25.71 % and 22.85%) as compared to Gr. C (2.85 %, 5.71 % and 2.85 %). Difference for all the above parameters was statistical significant (p-value < 0.05). However 40 % of patients were drowsy, 82.85 % of patients had dryness of mouth, two patients (5.71 %) had bradycardia and hypotension in Clonidine group, whereas such observations were not made in Lignocaine group. Conclusion: Oral Clonidine at a dose of 4 mcg/kg body weight (up to a maximum limit of 200 mcg) therefore can be considered as better option than time tested intravenous Lignocaine
Journal of Clinical Anesthesia, 1991
Study Objective: To determine the effects of oral clonidine prc~medication on sedative, unxiolytic, and hemodynumic responses during the immediate preoperati-i)e period, lavyngoscopylintubation, und postanesthetic reco7levT. Design: Randomized double-blind assignment to one of four treakent group.\ (clonidine 0.1 mg, clonidine 0.2 mg, triazolarn 0.25 mg, or placebo); n = IO per <TOUP. Setting: Inpntient surge9 in a university-staffed tertiary center. Patients: Forty ASA physical status I and II adults qf both .sexe.s .scheduled for (I variety of procedures requiring general anesthesia. Interientions: Anxiety and sedation scored on ordinal scale ut time qf treatmevlt and 90 minutes later, jmt prior to anesthetic induction. Stundardized induction protocol with automated hemodynamic monitoring at I -minute inter&s and a 45second lavyngoscopy to ensure a vigorous .ctress response. Measurements and Main Results: Trinzolavn and both dosrs of clonidzne increased sedation at 90 minutes both absolutely and compared with u placebo. Clonidine 0.2 mg decreased anxiety absolutely ut 90 minutes but no more tharl (1 placebo. Clonidine 0.2 mg decreused systolic, mean, and diastolic blood pressure.! (BPS) but not heart rate (HR) at 90 minutes. Clonidine 0.2 tng also blunted the increase in systolic blood pressure (SP) [but not in diastolic blood pressure (DP) or HR] that accompanied lavyngoscopy. There were no treatment differences in postanesthetic hemodynamics or duration ?f reco-ifevy. Conclusions: Oral clonidine 0.2 mg was #e&vu in reduczng the le7lel of be-186 J. <Iin. Anesth., vol. 3, May/June 1991 havioral and hemodynamic responses preoperatively and in blunting systolic hypertension produced by prolonged laryngoscopy.
Background and objectives: Laryngoscopy and tracheal intubation is invariably associated with a reflex sympathetic pressor response resulting in elevated heart rate and blood pressures. This may prove detrimental in high risk patients. The main objectives of the present study are: To study the effect of intravenous magnesium sulphate 30 mg/kg with intravenous lignocaine 1.5mg/kg, and intravenous clonidine 3mcg/kg with intravenous lignocaine 1.5mg/kg on changes in the Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and Mean arterial blood pressure (MAP) during laryngoscopy and intubation under general anesthesia. Methods: 60 ASA I and II status normotensive patients scheduled for elective surgical Procedures were selected randomly and divided into three groups of 20 each. All patients received premedication with study drug. Induction of anesthesia was standardized for all patients who received, thiopentone 5 mg/kg i.v. and preservative free lignoaine 1.5mg i.v and were relaxed with succinylcholine 2mg/kg i.v. and laryngoscopy and intubation is done with appropriate sized endotracheal tube. HR, systolic, diastolic blood pressure were recorded noninvasively before induction, postintubation, 1,3,5,7 and 10 minutes from the onset of laryngoscopy. 'z' test was used for statistical analysis. Results: The basal and pre laryngoscopy mean SBP and standard deviations in CL group were 122.15 +/-8.12 and114.50 +/-7.30 respectively. In ML group basal systolic blood pressure was 117.30-+-/-9.78. After giving study drug prelaryngoscopy SBP decreased by 3mm of mm Hg to 114.15 +1-15.26. Conclusion: Both study drugs were more effective in attenuation of pressor response to intubation than when lignocaine alone was used
Journal of Evidence Based Medicine and Healthcare, 2019
BACKGROUND Endotracheal intubation is considered gold standard in patients undergoing general anaesthesia. Direct laryngoscopy and tracheal intubation result in an increase in blood pressure and heart rate, the so called 'pressor response'. Various techniques and drugs have been used in the past to attenuate the pressor response, however none has been proved to be ideal. We conducted this study to compare any possible blunting of cardiovascular effects of laryngoscopy and tracheal intubation by the use of 150 mg pregabalin or 200mcg clonidine with the group that did not receive any of the two drugs. MATERIALS AND METHODS 90 ASA Grade 1 and 2 patients aged 18-60 years of both genders were recruited for the study with 30 patients in each group. Group A-Received oral pregabalin 150 mg with sip of water 120 min before the surgery. Group B-Received oral clonidine 200 mcg with sip of water 120 min prior to surgery. Group COral placebo (multivitamin) with sip of water 120 min prior to surgery. On arrival in the operating room, HR, SBP, DBP, MAP were recorded at baseline, after induction, 1-, 3-, 5-and 10-mins after laryngoscopy and intubation. RESULTS In this study, there was a significant reduction in HR, SBP, DBP, MAP after laryngoscopy and intubation in pregabalin and clonidine group in comparison to control group. Oral premedication with pregabalin as well as clonidine attenuates the haemodynamic response to laryngoscopy and intubation with clonidine being superior to pregabalin.
International Journal of Research in Medical Sciences, 2018
Background: Laryngoscopy and endotracheal intubation causes stimulation of symphatho-adrenal system resulting in increase in blood pressure and heart rate. The present study compared oral clonidine, gabapentin and placebo premedication in attenuating haemodynamic response to laryngoscopy and endotracheal intubation.Methods: About 90 adult patients of ASA grade I and II patients in age group of 18-60 yrs, of either sex posted for surgery under general anaesthesia were randomly divided into three groups (30 patients in each group). The study drugs were given orally 90minutes before induction. Group 1 and Group 2 were pre treated with oral clonidine (0.2mg) and gabapentin (800mg) respectively and Group-3 received placebo. The HR, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded before induction of anesthesia and 1, 3, 5, 10min after laryngoscopy and intubation.Results: It was found that both clonidine and gabapentin reduces HR, SBP, DBP, ...
Journal of Evidence Based Medicine and Healthcare, 2016
Direct laryngoscopy and endotracheal intubation are the most stressful periods during induction of anaesthesia. These events can lead to hypertension, tachycardia, arrhythmias and myocardial ischaemia. Dexmedetomidine, an alpha-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilising properties without significant respiratory depression. AIM The aim of the study is to compare the efficacy of Dexmedetomidine against Lignocaine in attenuation of haemodynamic response of laryngoscopy and endotracheal intubation. METHODS A randomised controlled study was designed with total of 60 patients of which 30 patients received dexmedetomidine (Group D) 1 mcg/kg IV infusion 10 minutes prior to endotracheal intubation and 30 patients received 1.5 mg/kg of lignocaine intravenous (Group L) 3 mins. prior to endotracheal intubation. Inj. Thiopentone was given until eyelash reflex disappeared and intubation was facilitated with succinylcholine. Anaesthesia was maintained with 33:66 Oxygen: Nitrous oxide, halothane, and vecuronium. The patients were evaluated for change in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) & heart rate (HR) during pre-induction, just prior to induction at 0,1,3,5 & 10 mins. after laryngoscopy & intubation. Any adverse effects of the drugs were noted. RESULTS The two groups were comparable regarding age, sex, weight and type of surgeries. The HR, SBP, DBP, and MAP values were significantly lower in Group D at induction and statistically lower at 1, 3, 5, and 10 mins. when compared to Group L. CONCLUSION Dexmedetomidine attenuates the haemodynamic stress response to laryngoscopy and intubation more effectively when compared with lignocaine without any adverse effects.