Comparison of Clonidine versus Gabapentin as an Oral Premedication on Haemodynamic Response to Laryngoscopic and Tracheal Intubation in ENT Surgeries: A Double Blind, Randomised Clinical Study

Introduction: Laryngoscopy and tracheal intubation are recognised as potent stimuli which cause significant haemodynamic responses. Various pharmacological strategies have been employed to attenuate the haemodynamic responses associated with this, including opioids, beta-blockers, calcium channel blockers, and α-2 adrenergic agonists. Aim: The present study aimed to compare the efficacy of oral clonidine versus oral gabapentin in attenuating haemodynamic responses during laryngoscopy and endotracheal intubation. Materials and Methods: The present study was a double blinded, randomised clinical study and it was conducted at Dhiraj Hospital from April 2024 to April 2025. The study was approved by the Institutional Ethics Committee (SVIEC/ON/ Medi/SRP/April/24/76) and registered with Clinical Trials Registry - India (CTRI/2024/10/075366). Sixty patients aged 18-60 years of American Society of Anaesthesiologist physical status I-II, posted for elective surgeries under general anaesthesia were randomised into two groups (n=30 each): Group Dg received oral gabapentin 800 mg and Group Dc received oral clonidine 0.2 mg, 30 minutes prior to induction. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) were noted at baseline, after medication, after induction, during intubation, and at 1, 3, 5, and 7 minutes post-intubation. Data were analysed using unpaired Student’s t-test for numerical variables and Chi-square test for categorical variables. Statistical significance was set at p<0.05. Results: Demographic profiles were comparable between groups. The mean age of patients was 39.97±9.92; 44.23±11.72 years (p=0.13), gender distribution showed 46.67%; 36.67% males (p=0.43), ASA I physical status 66.67%; 70% (p=0.78) in Group Dg and Group Dc, respectively. During intubation, HR was 91.83±6.84 bpm; 97.10±11.38 bpm, p=0.0338 in Group Dc and Group Dg, respectively. During intubation, 1, 3, 5 and 7 minutes post-intubation, SBP (143.20±7.30: 127.73±5.06, 137.40±7.22: 118.03±6.36, 131.33±5.93: 108.70±8.16, 127.80±6.65: 105.87±9.73, 123.73±6.33: 104.27±8.74, p<0.0001), DBP (105.23±6.04: 87.33±8.87, 102.23±5.30: 87.50±6.31, 98.77±5.26: 81.97±6.71, 94.83±5.76: 76.63±7.42, 91.33±6.21: 70.27±8.13) in Group Dc and Group Dg, respectively. Conclusion: Oral clonidine is better than oral gabapentin at reducing the HR and especially the blood pressure spikes that occur during laryngoscopy and endotracheal intubation for general anesthesia. This makes clonidine a potentially better choice for premedication, particularly for patients at higher risk of heart problems.