Evaluation of the Eff ectiveness of Oral Tablet Clonidine as a Premedicant Drug: A Prospective Study of 100 Cases

B Brinda; S Chakravarthy; S Manjunatha Prasad

B Brinda Professor, Department of Emergency Medicine
S Chakravarthy Registrar, Anesthesiology & Critical Care
S Manjunatha Prasad Senior Resident, Department of Anesthesiology & Critical Care

Keywords: Hemodynamic response, Oral clonidine, Premedication

Abstract

Introduction: Premedication is used to provide sedation and anxiolysis and to enhance the quality of induction; maintenance
and recovery from anesthesia. The ideal pre-medicant should be orally effective has sedative; analgesic, anti-anxiety, antisialagogue
and anti-emetic properties. And maintain cardiovascular stability and normal respirations.
Objectives: To evaluate the effectiveness of oral clonidine as a preanesthetic medicant and as a drug, to attenuate the
hemodynamic responses associated with laryngoscopy and endotracheal intubation.
Materials and Methods: Study was performed on 100 patients of the age group 18-65 years in whom 4 μg/kg body weight of oral
clonidine (max 0.2 mg) was administered 90 min prior to induction of anesthesia. Degree of sedation, anxiolysis, antisialagogue
effect and changes in heart rate, systolic blood pressure (BP), diastolic BP, mean arterial pressure and electrocardiogram
changes before and after premedication with oral clonidine was noted. Descriptive statistical analysis was done using statistical
software namely SPSS 15.0, Stata 8.0, MedCalc 9.0.1 and Systat 11.0 were used for the analysis of the data and Microsoft
word and Excel are used to generate graphs, and tables.
Results: Clonidine produced signifi cant sedation with a P <0.05, before premedication 61% of patients had anxiety score
of 1 and 27% had a Score of 2 and after premedication 77% had a Score of zero and 19% had Score 1, which is signifi cant
anxiolysis. The association that is observed between clonidine as anti-sialogogue is mildly signifi cant statistically. Premedication
with clonidine produced decrease in pulse rate, decrease in systolic, diastolic and mean arterial pressure was highly signifi cant
statistically P < 0.001. These values remained lower than the basal value after 1 min up to 5 min after intubation.
Conclusion: The premedication with oral clonidine produces signifi cant sedation, anxiolysis, mild anti-sialagogue effect and
hemodynamic stability during laryngoscopy and endotracheal intubation with no adverse effects. Thus, oral clonidine may be
used as an ideal pre-anesthetic medication.

Author Biographies

B Brinda, Professor, Department of Emergency Medicine

Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India

S Chakravarthy, Registrar, Anesthesiology & Critical Care

Sri Siddartha Medical College, Tumkur, Karnataka, India

S Manjunatha Prasad, Senior Resident, Department of Anesthesiology & Critical Care

Sri Siddartha Medical College, Tumkur, Karnataka, India

References

1. Rav al DL. Oral clonidine premedication for the attenuation of
haemodynamic response to laryngoscopy and intubation. Indian J Anaesth
2002;46:124-9.
2. Ghignone M, Quintin L, Duke PC, Kehler CH, Calvillo O. Effects
of clonidine on narcotic requirements and hemodynamic response during induction of fentanyl anesthesia and endotracheal intubation.
Anesthesiology 1986;64:36-42.
3. Nishikawa T, Taguchi M. Effects of clonidine premedication upon
haemodynamic changes associated with laryngoscopy and tracheal
intubation. Br J Anaesth 1991;40:1083-8.
4. Corbett JL, Kerr JH, Prys-Roberts C. Cardiovascular responses to
aspiration of secretions from the respiratory tract in man. J Physiol
1969;201:51P-2.
5. Stoelting RK, Hillier SC, editors. Antihypertensive drugs. In: Pharmacology
& Physiology in Anesthetic Practice. 4th ed. Philadelphia: Lippincott
Williams & Wilkins; 2006. p. 338-51.
6. Bergendahl H, Lönnqvist PA, Eksborg S. Clonidine: An alternative to
benzodiazepines for premedication in children. Curr Opin Anaesthesiol
2005;18:608-13.
7. Bergendahl H, Lönnqvist PA, Eksborg S. Clonidine in paediatric
anaesthesia: Review of the literature and comparison with benzodiazepines
for premedication. Acta Anaesthesiol Scand 2006;50:135-43.
8. Morgan GE, Michael MS, Murray MJ. Adrenergic agonists and antagonists.
In: Clinical Anesthesiology. 3rd ed. New York: McGraw Hill; 2002. p. 216-7.
9. Collins VJ. Principles of pre anesthetic medication. In: Principles of
Anesthesiology. 3rd ed. Malvern: Lea & Febiger; 1993. p. 292.
10. Stoelting RK, Hillier SC, editors. Antihypertensive drugs. In: Pharmacology
and Physiology in Anesthetic Practice. 4th ed. Philadelphia: Lippincott
Williams & Wilkins; 2006. p. 340-3.
11. Moss J, Glick D. The Autonomic nervous System. In: Miller RD, editor.
Miller’s Anesthesia. 6th ed. Philadelphia: Churchill Livingstone; 2005.
p. 650-1.
12. Maze M, Tranquilli W. Alpha-2 adrenoceptor agonists: Defi ning the role in
clinical anesthesia. Anesthesiology 1991;74:581-605.
13. Das AK. Clinical effi cacy of oral clonidine as preanaesthetic medicant.
Indian J Anaesth 1995;43:133.
14. Carabine UA, Wright PM, Howe JP, Moore J. Cardiovascular effects
of intravenous clonidine. Partial attenuation of the pressor response to
intubation by clonidine. Anaesthesia 1991;46:634-7.
15. Orko R, Pouttu J, Ghignone M, Rosenberg PH. Effect of clonidine on
haemodynamic responses to endotracheal intubation and on gastric acidity.
Acta Anaesthesiol Scand 1987;31:325-9.
16. Wright PM, Carabine UA, McClune S, Orr DA, Moore J. Preanaesthetic
medication with clonidine. Br J Anaesth 1990;65:628-32.
17. Weindler J, Kiefer RT, Rippa A, Wiech K, Ruprecht KW. Low-dose oral
clonidine as premedication before intraocular surgery in retrobulbar
anesthesia. Eur J Ophthalmol 2000;10:248-56.