Comparison of Clonidine and Midazolam Premedication Before Endoscopic Sinus Surgery: Results of Clinical Trial

Abstract

ObjectivesPremedication with clonidine has been found to reduce the bleeding during endoscopic sinus surgery (ESS), therefore lowering the risk of surgical complications. Premedication is an essential part of pre-surgical care and can potentially affect magnitude of systemic stress response to a surgical procedure. The aim of this study was to compare the efficacy of premedication with clonidine and midazolam in patients undergoing sinus surgery.MethodsForty-four patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or midazolam as a premedication before receiving propofol/remifentanil total intravenous anesthesia. The effect of this premedication choice on anesthetic requirements, intraoperative hemodynamic profile, preoperative anxiety and sedation as well as postoperative pain and shivering were examined in each premedication group.ResultsTotal intraoperative remifentanil requirement was lower in the clonidine group as compared to the midazolam group 503.2±147.0 µg vs. 784.5±283.8 µg, respectively (P<0.001). There was no difference between groups in required induction dose of propofol, level of preoperative anxiety, level of sedation and postoperative shivering. Intraoperative systemic blood pressure and heart rate response had a more favorable profile in patients premedicated with clonidine. Postoperative pain assessed by visual analogue scale for pain was lower in the clonidine group compared with to the midazolam premedication group.ConclusionPremedication with clonidine provides better attenuation of hemodynamic response and reduction of intraoperative remifentanil requirements in patients undergoing ESS. Postoperative pain seems to be better controlled after clonidine premedication as well.

The Role of Clinical Characteristics in Stratifying Sedation Risk: A Cohort Study

“…In a similar 2005 study, Pena et al studied prior endoscopic procedures, history of drug and alcohol use, and nervousness before procedure to predict adverse endoscopic experiences [ 11 ]; similar to Bal et al [ 10 ], they found nervousness and psychotropic drug use to be significantly associated with adverse events. Other interesting patient factors that have been considered include marijuana use, which was found to be associated with higher sedation demands by Twardowski et al in 2019 [ 12 ].…”

A comparative study of midazolam alone or in combination with dexmedetomidine or clonidine for awake fiberoptic intubation

“…Similar result was obtained in the study conducted by Patel et al [62324] However, in another two studies, midazolam group achieved desired RSS (3–4) significantly earlier than patients in dexmedetomidine group, while no difference is seen between clonidine and midazolam group. [2526] We have used bolus dose (0.04 mg/kg) of midazolam in all the three groups, which could have acted synergistically with dexmedetomidine and clonidine to achieve the desired RSS faster. In our study, the time to achieve RSS ≥2 by Group D was 5.53 ± 0.74, which is similar to the result obtained by Cattano et al [2] Among α2 agonist, Group D took lesser time to achieve target RSS as compared to Group C, as dexmedetomidine is 8 times more specific for α2 receptors, especially for 2A subtype, thus making it a more effective sedative agent as compared to clonidine.…”

“…Cardiovascular response to the procedure and intubation was more favorable in Groups D and C as compared to Group M. We found consistent decrease in HR and MAP during a bolus infusion of 10 min and less intubation response. [7102629] The lower HR in Group D and Group C than Group M can be explained on the basis of hemodynamic effects of dexmedetomidine and clonidine as these drugs cause a decrease in noradrenaline release and diminish centrally mediated sympathetic tone. [30] Intubation stress response was also diminished in Group D and C, which is explained by the property of attenuation of sympathetic response of intubation by α2 agonists.…”

“…[15] After the intubation, responses due to FOB and intubation might be masked due to the added hemodynamic changes brought about by the induction of general anesthesia once the ETT position was confirmed. [1026] The respiratory parameters were comparable among the three groups. [47] The event of desaturation was more in Group C when compared to Groups M and D, with maximum fall between 3 and 4 min of bronchoscopy.…”

Clonidine or remifentanil for adequate surgical conditions in patients undergoing endoscopic sinus surgery: a randomized study

“…Both clonidine and remifentanil have been used and studied in the setting of controlled hypotension ( Wawrzyniak, Kusza & Cywinski, 2014 ; Miłoński et al, 2013 ; Mohseni & Ebneshahidi, 2011 ; Marchal et al, 2001 ; Lee et al, 1999 ; Hackmann et al, 2003 ; Yun, Kim & Kim, 2015 ; Cardesin et al, 2015 ). These drugs decrease blood loss by decreasing the blood pressure and, more specifically, the cardiac output.…”