Efficacy of Intravenous Clonidine Premedication in the Prevention of Adverse Hemodynamic Changes During Intubation in Patients Undergoing Laparoscopic Surgery in Comparison with Placebo.

Abstract

Context: Laparoscopic surgeries involve the creation of pneumoperitoneum, which produces significant hemodynamic changes. Alpha-2 adrenergic receptor agonists like clonidine are used as adjuvants during aesthesia for analgesic, sedative, sympatholytic and cardiovascular stabilizing effects.

Aims: This study aims to assess the efficacy of intravenous (i.v.) clonidine premedication in the prevention of adverse hemodynamic changes during intubation in a patient undergoing laparoscopic surgery in comparison with (normal saline) placebo.

Settings and design: Eighty patients undergoing elective laparoscopic surgery were randomly assigned into two groups to receive either clonidine 3 μg.kg^-1 diluted in normal saline or an equivalent quantity of normal saline administered intravenously 20 min before surgery.

Materials and methods: The primary outcome was to compare the efficacy of clonidine premedication in the prevention of adverse hemodynamic changes during intubation in patients undergoing laparoscopic surgery. Other outcome parameters observed were requirements of induction agents and intraoperative analgesia and postoperative adverse effects.

Statistical analysis used: Analysis of variance has been used to find the significance of study parameters between three or more groups of patients; Chi-square/Fisher exact test has been used to find the significance of study parameters on a categorical scale between two or more groups.

Results: Heart rate reduced significantly after 10 min 3 μg.kg^-1 clonidine administration and the decrease persisted throughout induction and intubation. The fluctuations of systolic, diastolic, and mean arterial pressures were high in the control group when compared with the clonidine group, throughout induction and intubation.

Conclusions: Premedication with i.v. clonidine is a relatively safe and effective method that provides stable hemodynamics and protection against stress responses induced during laryngoscopy and intubation in patients undergoing laparoscopic surgery.