Published: 2018-11-26

Effect of clonidine and gabapentin as oral premedication on hemodynamic response to laryngoscopy and tracheal intubation

Prabhati R. Mishra, Manmaya Padhy, Rusikesh Satapathy, Monali Kar


Background: Laryngoscopy and endotracheal intubation causes stimulation of symphatho-adrenal system resulting in increase in blood pressure and heart rate. The present study compared oral clonidine, gabapentin and placebo premedication in attenuating haemodynamic response to laryngoscopy and endotracheal intubation.

Methods: About 90 adult patients of ASA grade I and II patients in age group of 18-60 yrs, of either sex posted for surgery under general anaesthesia were randomly divided into three groups (30 patients in each group). The study drugs were given orally 90minutes before induction. Group 1 and Group 2 were pre treated with oral clonidine (0.2mg) and gabapentin (800mg) respectively and Group-3 received placebo. The HR, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded before induction of anesthesia and 1, 3, 5, 10min after laryngoscopy and intubation.

Results: It was found that both clonidine and gabapentin reduces HR, SBP, DBP, MAP than placebo group at lminute, 3minutes, 5minutes and 10minutes after intubation. But reduction is more with clonidine as compared to gabapentine and difference was statistically significant (P = <0.0001).

Conclusions: Both oral clonidine and gabapentine attenuate hemodynamic response to laryngoscopy and endotracheal intubation but effect is better with clonidine than oral gabapentine.


Clonidine, Gabapentin, Hemodynamic response, Intubation, Laryngoscopy

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Henderson J. Airway management in the adult. Miller’s Anesthesia. 7th ed. Philadelphia, Churchill Livingstone Elsevier;2010:1573‑609.

Rose DK, Cohen MM. The airway: Problem and predictions in 18,500 patients. Can J Ana. 1994;41:372‑83.

Rosenblatt WH, Barash PG, Cullen BF, Stoelting RK. Airway management. Clinical anesthesia, Philadelphia. Lippincott Williams and Wilkins. 2001;4:595-638.

Kong VK, Irwin MG. Gabapentin: A multimodal perioperative drug? Br J Anaesth. 2007;99:775‑86.

Turan A, Kaya G, Karamanlioglu B, Pamukcu Z, Apfel CC. Effects of oral gabapentin on postoperative analgesia. Br J Anaesth. 2006;96:242‑6.

Segal AZ, Rodorf G. Gabapentin as a novel treatment for post herpetic neuralgia. Neurology. 1996;46:1175‑6.

Rosmer H, Rubin L, Kestenbaum A. Gabapentin adjunctive therapy in neuropathic pain states. Clin J Pain. 1996;12:56‑8.

Zapp JJ. Post poliomyelitis pain treated with gabapentin. Am Fam Physician. 1996;53:2442-5.

Mellick GA, Mellick LB. Reflex sympathetic dystrophy treated with gabapentin. Arch Phys Med Rehabil. 1997;78:98‑105.

Backonja M, Baydoun A, Edwards K R, Schwartz S L, Fonseca V, Hes M, et al. Gabapentin for the sympathetic treatment of painful neuropathy in patients with diabetes mellitus: A randomized control trial. JAMA. 1998;280:1831‑6.

Rose MA, Kam PC. Gabapentin: Pharmacology and its use in pain management. Anaesthesia. 2002;57:451‑62.

Eisenach JC, De Kock M, Klimscha W. α2-adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984-1995). Anesthesiology. 1996;85:655-74.

Ghignone M, Calvillo O, Quintin L. Anesthesia and hypertension: The effect of clonidine on preoperative hemodynamic and isoflurane requirements. Anesthesiology. 1987;67:3‑10.

Carabine UA, Wright PM, Moore J. Preanaesthetic medication with clonidine: A dose response study. Br J Anaesth. 1991;67:79‑83.

Smith HM, Bacon DR. The history of Anaesthesia. In: Barash PG. Cullen BF, Stoeiting RK. Clinical Anesthesia. 7th ed. Philadelphia. Lippincott Williams and Wilkins:2016.

Rachael KS, James EP. Pre-operative Gabapentin for post- operative analgesia: a meta analysis. Can J Anaes. 2006;53:461-69.

Memis D, Turan A, Karamamlioglu B, Seker S, Ture M. Gabapentin reduce cardiovascular responses to laryngoscopy and tracheal intubation. Eur J Anaesthesiol. 2006;23:686‑90.

Koc S, Memis D, Sut N. The preoperative use of gabapentin, dexamethasone and their combination in varicocele surgery:A randomized controlled trial. Anesth Ana. 2007;105:1137-42.

Bafna U, Goyal VK, Garg A. A comparison of different doses of gabapentin to attenuate the hemodynamic response to laryngoscopy and tracheal intubation in non-notensive patients. J Anaesthesiol Clin Pharmacol. 2011;27(1):43-6.

Filos KS, Patroni O, Goudas LC, Bosas O, Kassaras A, Gartaganis S. A dose-response study of orally administered clonidine as premedication in the elderly: evaluating hemodynamic safety. Anesthesia & Analgesia. 1993 Dec 1;77(6):1185-92.

Yu HP, Hseu SS, Teng YH, Chan KH. Oral clonidine premedication preserves heart rate variability for patients undergoing larparoscopic cholecystectomy. Acta Anaesthesiol Scan. 2003;47:185-90.

Gupta PK, Sehgal R, Gupta M, Kawatra R. Attenuation of cardiovascular response to ketamine: comparative evaluation of lignocaine and clonidine. Indian J Anaesth. 2002;46(6):457-9.

Fassoulaki A, Melemeni A, Paraskeva A, Petropoulos G. Gabapentin attenuates the pressure response to direct laryngoscopy and tracheal intubation. Br J Anaesth. 2006;96:769-73.

Kaya FN, Yavascaoglu B, Baykara M, Altun GT, Gülhan N, Ata F. Effect of oral gabapentin on the intraocular pressure and haemodynamic responses induced by tracheal intubation. Acta Anaesthesiologica Scandinavica. 2008 Sep;52(8):1076-80.

Marashi SM, Ghafari MH, Saliminia A. Attenuation of hemodynamic responses following laryngoscopy and tracheal intubation‑comparative assessment of clonidine and gabapentin premedication. Middle East J Anesthesiol. 2009;20:233‑7.

Marashi SM, Ghafari MH, Saliminia A. Attenuation of hemodynamic responses following laryngoscopy and tracheal intubation. MEJ Anesth. 2009;20(2):233-7.

Montazeri K, Kashefi P, Honarmand A, Safavi M, Hirmanpour A. Attenuation of the pressure response to direct laryngoscopy and tracheal Intubation: oral clonidine vs. oral gabapentin premedication. J Res Med Sci. 2011;16(Suppl 1):377-86.

Majumdar S, Das A, Das H, Bandyopadhyay S, Hajra BK, Mukherjee D, et al. Comparative evaluation of oral gabapentin versus clonidine as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anesthesia. Perspect Clin Res. 2015;6(4):211-6.