DOI: http://dx.doi.org/10.18203/2349-3933.ijam20191475

Oral clonidine versus intravenous fentanyl in attenuation of hemodynamic responses to larngoscopy and endotracheal intubation: a comparative study

Rukmini G., Srinivas M. Reddy

Abstract


Background: During endotracheal intubation, it has been observed that there is evolvement of the responses of the circulatory in nature. These are difficult to control using the IV anesthetic drugs. Hence various agents are tried to overcome this drawback. Objective of research work was to study efficacy of oral clonidine on hemodynamic responses compared to IV fentanyl while patients undergo larngoscopy and endotracheal intubation.

Methods: The patients were allocated into two groups of 30 each. i.e. 30 patients in clonidine group and 30 patients in fentanyl group. All the patients received were pre-medicated with glycoprrolate 0.2mg, ondansetron 4mg and tramadol 1mg/kg body weight. Cardiovascular parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure,) were recorded at the following intervals: pre-induction, after induction, at endotracheal intubation, one minute, three minutes and five minutes after intubation.

Results: The heart rate was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. The systolic blood pressure was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. The diastolic blood pressure was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. Similar was the case with mean arterial blood pressure.

Conclusions: Clonidine has been found to be more effective than IV fentanyl in stabilizing the cardiovascular parameters. Not only that orally it is easier to administer and cost effective.


Keywords


Attenuation, Endotracheal intubation, Fentanyl, Hemodynamic responses, Laryngoscopy

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References


Kayhan Z, Aldemir D, Mutlu H, Öğüş E. Which is responsible for the hemodynamic response due to the laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin? Eur J Anesthesiol. 2005;22:780-5

Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1996;8:63-79.

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

Prys-Roberts C, Foex P, Biro GP. Studies of anaesthesia in relation to hypertension versus adrenergic β receptor blockade. Br J Anesth. 1973;45:671-80.

Chung KS, Sinatra RS, Chung JH. The effect of an intermediate dose of labetalol on heart rate and blood pressure responses to laryngoscopy and intubation. J Clin Anesth. 1992;4(1):11-5.

Ko SH, Kim DC, Han YJ, Song HS. Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation. Anesth Analg. 1998;86(3):658-61.

Adachi YU, Satomoto M, Higuchi H, Watanabe K. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anesthesia Analgesia. 2002;95(1):233-7.

Chadha R, Padmanabhan V, Joseph A, Mohandas K. Oral clonidine pretreatment for hemodynamic stability during craniotomy. Anaesth Intensive Care. 1992;20(3):341-4.

Laurito CE, Baughman VL, Becker GL, Cunningham F, Pygon BH, Citron GM. Oral clonidine blunts the hemodynamic responses to brief but not prolonged laryngoscopy. J Clin Anaesth. 1993;5(1):54-7.

Mikawa K, Maekawa N, Nishina K, Takao Y, Yaku H, Obara H. Efficacy of oral clonidine premedication in children. Anesthesiol. 1993;79:926-931.

Raval DL, Mehta MK. Oral clonidine premedication for attenuation of hemodynamic response to laryngoscopy and intubation. Indian J Anaesth. 2002;46(2):124-9.

Sessler DI, Kentucky L, Treatment; mepiridine, clonidine, doxapram, ketaserin, or alfentanil abolishes short term post-operative shivering. Can J Anesth. 2003;50;635-7.

Iizawa A, Oshima T, Kasuya Y, Dohi S. Oral Tandospirone and Clonidine provide similar relief of post operative anxiety. Can J Anesth. 2004;51:668-71.

Pawlik MT, Hansen E, Waldhauser D, Selig C, Kuehnel TS. Clonidine premedication in patients with sleep apnea syndrome: a randomized, double-blind, placebo-controlled study. Anesthesia Analgesia. 2005;101(5):1374-80.