Comparative evaluation of oral clonidine and midazolam as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anaesthesia

Context: Laryngoscopy and endotracheal intubation is associated detrimental hemodynamic changes like rise in blood pressure (BP), heart rate (HR) leading to adverse cardiological outcome specially in susceptible individuals. Aims: To compare the blood pressure (BP) and heart rate (HR) changes during laryngoscopy and endotracheal intubation as well as to evaluate the preoperative sedation status between oral clonidine and oral midazolam as premedication for the patients undergoing general anesthesia (GA). Settings and Design: Fifty patients between 18 and 60 years of age of either sex of American Society of Anesthesiologists (ASA) Grade I and II undergoing GA were randomly divided into two equal groups of 25 patients each. Group-C patients received clonidine 4 mcg/kg orally and Group-M patients received 0.5 mg/kg midazolam orally as premedication. Materials and Methods: After measuring baseline hemodynamic parameters patients of both groups received premedication. Preoperative sedation was assessed 2 hr after premedication administration. Standard anesthetic technique was followed. Hemodynamic (HR, BP) parameters were noted baseline, immediately after laryngoscopy and intubation and 5 min after intubation to observe the stress response. Results and Statistical Analysis: A significant difference in pre-operative sedation between two groups (P < 0.05) and midazolam (group M) produced significantly better sedation than clonidine (group C). Laryngoscopic stress response in group C was still at a lower level than baseline values and significantly (P < 0.005) less than group M. Conclusions: Oral midazolam is more effective in producing preoperative sedation than oral clonidine while on the contrary oral clonidine is more efficacious in reducing laryngoscopic stress response than oral midazolam. Laryngoscopy and intubation was better controlled by oral clonidine than midazolam.