Citation Information :
Kaur M, Kumari A, Chawla S, Gupta R. Intravenous Clonidine with Lignocaine Nebulization to Attenuate the Hemodynamic Response to Laryngoscopy and Tracheal Intubation: A Comparative Study. Curr Trends Diagn Treat 2021; 5 (1):26-30.
Introduction: The present study was conducted to compare the efficacy of intravenous (i.v.) clonidine with that of lignocaine nebulization for attenuation of pressor response to laryngoscopy and tracheal intubation.
Materials and methods: Fifty patients of either sex aged between 18 years and 60 years covered under American Society of Anesthesiologists health status classes I and II, undergoing elective surgery under general anesthesia requiring endotracheal intubation, were considered. Patients were randomly divided into two groups. Group A received i.v. clonidine 1 μg per kg and nebulization with 3 mg per kg of 4% lignocaine, and group B received i.v. normal saline and nebulization with 3 mg per kg of 4% lignocaine before intubation. Hemodynamic parameters were noted at baseline, after giving study drug, every minute after intubation for 10 minutes and then every 10 minutes thereafter till the end of the surgery.
Results: It was noted that in group A, the rise of HR, SBP, DBP, and MAP 1 minute after intubation was found to be 85.4 bpm, 117.5, 70.6, and 86.2 mm Hg, and in group B, the rise of HR, SBP, DBP, and MAP 1 minute after intubation was found to be 93.9 bpm, 129.9, 85.2, and 100.1 mm Hg, respectively. Nebulized lignocaine was not found effective in attenuating hemodynamic response to intubation, and hemodynamic parameters were significantly high after intubation as compared to clonidine group.
Conclusion: In our study, i.v. clonidine in a dose of 1 µg per kg administered 15 minutes before laryngoscopy, and intubation was far superior to nebulized lignocaine alone in attenuation of the hemodynamic response.
King BD, Harris LC, Greifenstein FE, et al. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology 1951;12(5):556–566. DOI: 10.1097/00000542-195109000-00002.
Henderson J. Airway management in the adult. In: Miller RD, editor. Miller's anesthesia. 7th ed. Philadelphia: Elsevier Churchill Livingstone; 2010. p. 1573–1610.
Prys-Robers C, Greene LT, Meloche R, et al. Studies of anaesthesia in relation to hypertension-II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971;43(6):531–547. DOI: 10.1093/bja/43.6.531.
Kovac AL. Controlling the haemodynamic response to laryngoscopy and endotracheal intubation. J Clinical Anesthesiol 1996;8(1):63–79. DOI: 10.1016/0952-8180(95)00147-6.
Stoelting RK. Blood pressure and heart rate changes during short duration laryngoscopy for tracheal intubation: influence of viscous or intravenous lignocaine. Anaesth Analg 1978;57(2):197–199. DOI: 10.1213/00000539-197803000-00009.
Dahlgreen N, Messeter K. Treatment of the stress response to laryngoscopy and intubation with fentanyl. Anaesthesia 1981;36(11):1022. DOI: 10.1111/j.1365-2044.1981.tb08676.x.
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 Anaesth 1992;4(1):11–15. DOI: 10.1016/0952-8180(92)90112-e.
Bhushanam Padala SA, Anakapalli M, Mangu HR, et al. Effect of sevoflurane with morphine or fentanyl on haemodynamic response to laryngoscopy and tracheal intubation: a prospective, randomised, double-blind study. J Clin Sci Res 2018;7(2):58–63. DOI: 10.4103/JCSR.JCSR_31_18.
MontazeriI K, Falah M. Dose-response study: MgSO4 in cardiovascular responses after laryngoscopy and endotracheal intubation. Canadian J Anesth 2005;52(S1):80. DOI: 10.1007/BF03023167.
Stoelting RK, Hiller SC. Antihypertensive drugs. In: Brain B, Frain M, editors. Pharmacology and physiology in anaesthetic practice. 4th ed. Philadelphia: Lippincott Williams and Wilkins Publishers; 2006. p. 343.
Soni B, Sheth P, Kapadia K. Comparative study of intravenous infusion of clonidine and/or magnesium sulphate on haemodynamic stress response to tracheal intubation and pneumoperitoneum during laparoscopic surgery. Natl J Med Res 2017;7(1):22–25.
R Cordeiro, SA D’Souza. Intravenous 2 μg/kg clonidine in comparison to intravenous 2 μg/kg fentanyl for attenuation of haemodynamic response to laryngoscopy and orotracheal intubation. J Evol Med and Dent Sci 2016;5(26):1366–1371. DOI: 10.14260/jemds/2016/322.
Arora S, Kulkarni A, Bhargava AK. Attenuation of hemodynamic response to laryngoscopy and endotracheal intubation using intravenous clonidine. J Anaesthesiol Clin Pharmacol 2015;31(1):110–114. DOI: 10.4103/0970-9185.150559.
Marulasiddappa V, Nethra HN. A comparative study of clonidine and lignocaine for attenuating pressor responses to laryngoscopy and tracheal intubation in neurosurgical cases. Anesth Essays Res 2017;11(2):401–405. DOI: 10.4103/0259-1162.194557.
Kalra NK, Verma A, Agarwal A. Comparative study of intravenously administered clonidine and magnesium sulphate on haemodynamic response during laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2011;27(3):344–348. DOI: 10.4103/0970-9185.83679.
Charan N, Hijam B, Ninave S, et al. A double blind comparative study of IV clonidine and fentanyl to see the haemodynamic response during laryngoscopy and intubation. J Evol Med Dent Sci 2014;3(39):10015–10025. DOI: 10.4103/0259-1162.194557.
Kulka PJ, Tryba M, Zenz M. Dose-response effects of intravenous clonidine on stress response during induction of anaesthesia in coronary artery bypass graft patients. Anaesth Analg 1995;80(2):263–268. DOI: 10.1097/00000539-199502000-00011.
Chinn WM, Zavala DC, Ambre J. Plasma levels of lidocaine following nebulized aerosol administration. Chest 1977;71(3):346–348. DOI: 10.1378/chest.71.3.346.
Laurito CE, Baughman VL, Becker GL, et al. Effects of aerosolized and/or intravenous lidocaine on hemodynamic responses to laryngoscopy and intubation in outpatients. Anesth Analg 1988;67(4):389–392.
Bunting HE, Kelly MC, Milligan KR. Effect of nebulized lignocaine on airway irritation and haemodynamic changes during induction of anaesthesia with desflurane. Br J Anaesth 1995;75(5):631–633. DOI: 10.1093/bja/75.5.631.
Kumar A, Seth A, Prakash S, et al. Attenuation of the hemodynamic response to laryngoscopy and tracheal intubation with fentanyl, lignocaine nebulization, and a combination of both: a randomized controlled trial. Anaesth Essays Res 2016;10(3):661–666. DOI: 10.4103/0259-1162.191113.
Meng YF, Cui GX, Gao W, et al. Local airway anesthesia attenuates hemodynamic responses to intubation and extubation in hypertensive surgical patients. Med Sci Monit 2014;20:1518–1524. DOI: 10.12659/MSM.890703.
Jokar A, Babaei M, Pourmatin S, et al. Effects of intravenous and inhaled nebulized lignocaine on the hemodynamic response of endotracheal intubation patients: a randomized clinical trial. Anesth Essays Res 2018;12(1):159–164. DOI: 10.4103/aer.AER_75_17.
Ganesan P, Balachander H, Elakkumanan LB. Evaluation of nebulized lignocaine versus intravenous lignocaine for attenuation of pressor response to laryngoscopy and intubation. Curr Med Issues 2020;18(3):184–188. DOI: 10.4103/cmi.cmi_50_20.
Acharya N, Routray D. A prospective randomized study of efficacy of clonidine in attenuating haemodynamic response to laryngoscopy and tracheal intubation. Ann Int Med Den Res 2017;3(2):AN30–AN34.
Chhatrapati S, Shitole AB. Efficacy of intravenous clonidine to attenuate cardiovascular stress response to laryngoscopy and tracheal intubation–a prospective randomized double blind study. Int J Cont. Med Res 2016;3(5):1462–1467.