ORAL CLONIDINE FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION IN KNOWN HYPERTENSIVE PATIENTS

Authors

  • Mujahid -ul- Islam
  • Imtiaz Ahmad
  • Khalid Rafique
  • Rehana Kamal
  • Faahad Abbas

Abstract

Background: Sympathetic response associated with laryngoscopy and endotracheal intubation isrecognised as a potential cause for a number of complications especially in hypertensive patients.Various methods have been used to attenuate these haemodynamic responses; however most of thestudies are in normotensive patients. The aim of our study was to compare the effect of oral clonidineand I/V fentanyl with oral placebo and I/V fentanyl in attenuating the haemodynamic responses tolaryngoscopy and intubation in known hypertensive patients. Method: In a double blind randomisedcontrolled trial, 60 hypertensive patients, taking antihypertensive drugs and with systolic blood pressurebelow 160 mmHg and diastolic blood pressure below 100 mmHg scheduled for elective surgeries,requiring oral endotracheal intubation and age ranging from 40–65 years were included in this studyand randomly divided into Group A (clonidine 0.2 mg + fentanyl 2 μg/Kg) and Group B (Placebo +fentanyl 2 μg/Kg). Results: Demographic data were comparable in both groups. There were nostatistically significant differences between the two groups in the duration of laryngoscopy andintubation. There was statistically significant attenuation in heart rate in both groups (p=0.020). Thetrends of attenuation of systolic blood pressure, diastolic blood pressure and mean arterial pressure inGroup A compared to Group B, were statistically significant (p=0.034, 0.011, 0.011 respectively).Conclusion: Clonidine, under the present study design attenuates the haemodynamic response tolaryngoscopy and endotracheal intubation in known hypertensive patients.Keywords: Clonidine, haemodynamic response, laryngoscopy, endotracheal intubation, hypertension

References

Reid LC, Brace DE. Irritation of the respiratory tract and its

reflex effect upon heart. Surg Gynecol Obstet 1940;70:157–62.

Bruder N, Granthil C, Ortega D. Consequences and prevention

methods of hemodynamic changes during laryngoscopy and

intubation. Ann Fr Anesth Reanim 1992;11(1):57–71.

Yao F-SF, Ho C-YA. Hypertension. In: Yao F-SF (Ed). Yao &

Artusio’s Anesthesiology: Problem-oriented patient

management. (5th ed). Philadelphia: Lippincott Williams and

Wilkins; 2003.p. 337–57.

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

Anaesth 1971;43:531–45.

Edwards ND, Alford AM, Dobson PMS, Peacock JE, Reilly CS.

Myocardial ischaemia during tracheal intubation and extubation.

Br J Anaesth 1994;73:537–9.

Aitkenhead AR, Rowbotham DJ, Smith G. Drugs acting on the

cardiovascular and autonomic nervous systems. In: Aitkenhead

AR, Rowbotham DJ, Smith G, (Eds). Textbook of Anaesthesia,

(4th ed). Edinburgh: Churchill Livingstone; 2001. p.65–100.

Kovac AL. Controlling the hemodynamic response to

laryngoscopy and endotracheal intubation. J Clin Anesth

;8:63–79.

Shribman AJ, Smith G, Achola KJ. Cardiovascular and

catecholamine responses to laryngoscopy with and without

tracheal intubation. Br J Anaesth 1987;59:295–9.

Derbyshire DR, Chmielewski A, Fell D, Vater M, Achola K,

Smith G. Plasma catecholamine responses to tracheal intubation.

Br J Anaesth 1983;55:855–60.

Ebert TJ, Trotier TS, Arain SR. High concentrations of isoflurane

do not block the sympathetic nervous system activation from

desflurane. Can J Anaesth 2001;48(2):133–8.

Morgan GE Jr, Mikhail MS, Murray MJ. Anaesthesia for patients

with cardiovascular disease. In: Morgan GE, Jr. Mikhail MS.

Murray MJ. (Eds). Clinical Anesthesiology (4th ed). New York:

McGraw Hill; 2006. p.441–89.

Shah TH. Tracheal intubation with neuromuscular block in

children. J Postgrad Med Inst 2004;18(1):117–23.

Raval DL, Mehta MK. Oral clonidine pre medication for

attenuation of haemodynamic response to laryngoscopy and

intubation. Indian J Anaesth 2002;45(2):124–9.

Downloads

Published

2012-12-01

Issue

Vol. 24 No. 3-4 (2012): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.