Comparison of Oral Clonidine with Oral Pregabalin Premedication for the Attenuation of Pressor Response to Direct Laryngoscopy and Tracheal Intubation in Elective Surgery: A Prospective Randomized Study

Laryngoscopy and intubation has adverse effects like tachycardia, hypertension, myocardial ischemia and cerebral hemorrhage. There are many studies on various pharmacological agents to attenuate pressor response. Aim of the study was to compare efficacy and safety of oral clonidine versus oral pregabalin premedication to attenuate stress response in patients undergoing elective surgery.

106 patients of American Society of Anesthesiologist (ASA) class I, aged between 18-60 years of either sex scheduled for elective surgery were randomized into two groups. Group A received oral clonidine 0.2mg and group B received oral pregabalin 150mg, 90 minutes before surgery. Primary objectives of the study heart rate(HR), systolic blood pressure(SBP) diastolic blood pressure(DBP) and mean blood pressure(MBP) were noted baseline, before induction, immediately after intubation (0) and at 1, 3, 5, 10 and 15 minutes after intubation. sedation, postoperative pain scores and any adverse effects were also noted.

The demographic data were comparable in group A and group B. There was no significant difference at baseline for mean (SD) HR, SBP, DBP, and MBP in both groups (p>0.05). The mean (SD) HR was significantly lower in group A as compared to group B, before induction and at 1, 3, 5, 10 and 15 minutes (p <0.05). The mean (SD) SBP, MBP was significantly lower in group A as compared to group B, before induction immediately after intubation and at 1, 3, and 5 minutes (p <0.05). The mean (SD) DBP was significantly lower in group A as compared to group B, before induction (p 0.012). but post-operative analgesia was better in pregabalin group. Bradycardia was more in clonidine group and sedation was more with the use of pregabalin.

We concluded that oral premedication with either clonidine or pregabalin attenuates hemodynamic response to laryngoscopy and tracheal intubation, but Clonidine is superior to pregabalin.