Reduction in Hemodynamic Changes during Direct Laryngoscopy and Intubation by Intravenous Clonidine or Nalbuphine Premedication - A Comparative Evaluation

Pressor response during Direct Laryngoscopy and Intubation

Abstract

Background: Accentuated hemodynamic changes during direct laryngoscopy can be modified by appropriate premedication. The present study was aimed to comparatively evaluate the clinical efficacy of intravenous clonidine with nalbuphine premedication for reduction in hemodynamic changes during direct laryngoscopy and intubation.  Subjects and Methods: Sixty adult consenting patients of ASA physical status I and II of either gender, were randomized into two equal groups of 30 patients each to receive either clonidine (2 g/kg) Group I or nalbuphine (0.2 mg/kg) Group II, intravenously 10 minutes before induction. Anesthetic technique was standardised and direct laryngoscopy with intubation was facilitated with vecuronium bromide. Changes in heart rate, arterial blood pressure and ECG were recorded at baseline, after giving study drug, after laryngoscopy and intubation, then after at 1st, 2nd, 3rd, 5th, 10th, and 15th min of intubation and were noted as primary end points. Any side effects and complications were recorded as secondary end points. Results: After premedication in patients of comparable demographic profile, the fall in heart rate and blood pressure showed statistically significant difference between the groups. After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups but persisted up to 5 to 7 min in patients of clonidine group and up to 10 minutes in patients of nalbuphine group with statistically significant difference between the groups. Conclusion: Intravenous clonidine premedication (2 g/kg) could effectively reduce the hemodynamic changes during direct laryngoscopy and intubation when compared to intravenous nalbuphine (0.2 mg/kg), administered 10 min before induction.