Santosh Kumar Bennur Anes 2013 KIMSB

136 Pages·2012·2.3 MB·English

“EFFECT OF ORAL CLONIDINE IN ATTENUATING STRESS
RESPONSE TO LARYNGOSCOPY AND INTUB ATION-
A RANDOMSED PLACEBO CONTROLLED STUDY”

by
Dr. SANTOSHKUMAR BENNUR
Dissertation Submitted to the

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore
In partial fulfilment of the requirements for the
degree of

DOCTOR OF MEDICINE
in
ANAESTHESIOLOGY
Under the guidance of
Dr. CHAYA. S.
M.D. D.A
PROFESSOR AND HEAD

DEPARTMENT OF ANAESTHESIOLOGY
KEMPEGOWDA INSTITUTE OF MEDICAL
SCIENCES, BENGALURU.

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU, KARNATAKA

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “Effect of oral clonidine in
attenuating stress response to laryngoscopy and intubation-A randomized
placebo controlled study” conducted at KIMS Hospital Bangalore is a bonafide
and genuine research work carried out by me under the guidance of Dr. Chaya. S.
M.D.D.A., Professor and Head, Department of Anesthesiology, Kempegowda
Institute of Medical Sciences, Bangalore.

Date: Signature of the candidate

Place: Bangalore Dr. Santoshkumar Bennur

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CERTIFICATE BY THE GUIDE

This is to certify that this dissertation entitled “Effect of oral clonidine in
attenuating stress response to laryngoscopy and intubation-A randomized
placebo controlled study” conducted at KIMS Hospital Bangalore is a bonafide
and genuine research work done by Dr. Santoshkumar Bennur in partial
fulfillment of the requirements for the degree of M.D in Anesthesiology.

Date: Signature of the Guide

Place: Bangalore Dr. Chaya .S.
M.D.D.A
Professor and Head
Department of Anesthesiology
KIMS, Bangalore

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ENODRSMENT BY THE HEAD OF THE DEPARTMENT
PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that this dissertation entitled “Effect of oral clonidine in
attenuating stress response to laryngoscopy and intubation-A randomized
placebo controlled study” conducted at KIMS Hospital Bangalore is a bonafide and
genuine research work carried out by Dr. Santoshkumar Bennur under the
guidance of Dr. Chaya. S. M.D.D.A., Professor and Head, Department of
Anesthesiology, Kempegowda Institute of Medical Sciences, Bangalore, in partial
fulfillment of the requirements for the degree of M.D in Anesthesiology.

Seal and signature of the HOD Seal and signature of the Principal

Dr. Chaya S Dr. Sudarshan M.K
M.D.D.A
Date: Date:
Place: Bangalore Place: Bangalore

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COPY RIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,
Karnataka shall have the rights to preserve, use and disseminate this dissertation in
print or electronic format for academic or research purpose.

Date:

Place: Bangalore Dr. Santoshkumar Bennur

© Rajiv Gandhi University of Health Sciences, Karnataka

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ACKNOWLEDGEMENTS

I thank almighty for having blessed me with the ability to accomplish this
task. I take this opportunity to express my heartfelt gratitude to my beloved parents
Sri. Nagaraj Bennur and Smt. Geeta Bennur for the dreams they have dreamt
and hardships they have went through to make me stand where I am today.
I consider myself fortunate to have Dr. Chaya S, MD, DA, Professor and
Head, Department of Anesthesiology as my guide and mentor. I express my deep
sense of gratitude for her constant encouragement, wise constructive judgement and
valuable guidance in this study. I express my heartfelt appreciation for her
optimistic attitude, professional expertise, superb talent, constant inspiration and
support, and encouraging words during the entire course of study which leaves me
indebted to her.
With profound sense of gratitude and utmost reverence, I consider it a
privilege to express my indebtedness to my Professors Dr. Narendra Babu M.C
and Dr. Madhav Reddy R. whose words of wisdom and encouragement have led
to the completion of this dissertation work.
I thank my Associate Professors, Dr. ShreeRaghu G.M, Dr. Vijayanand S
and Dr. Jyothsana for their encouragement and advice during the course of this
study.
I was fortunate to have the enthusiasm, knowledge and experience of my
beloved assistant professors Dr. Nagaraj A.S, Dr. Aswini, Dr. Vinod, Dr.
Hemanth, Dr. Ashok, Dr. Sreesha, Dr. Suraj and Dr. Mithun and sincerely
thank all of them for teaching me in their own unique way and encouraging me
throughout my course.
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I express my gratitude to my lecturers Dr. Shashikiran V, Dr. Vijay
Kumar H.G, Dr. kanakaraju M, Dr. Ram Prasad Harsha, Dr. Kiran S.K for
their constant source of encouragement during my study.
I thank all my senior and junior PG students and my fellow colleagues
for instilling in me the competitive spirit and encouraging me to do my best.
I express my sincere thanks and gratitude to Dr. M K Sudarshan , Dean
M.D
and Principal, Dr. Captain. G.S. Venkatesh, Medical director, Dr. I Suresh,
Medical superintendent and Dr. Veeranna Hospital Administrator
Kempegowda Institute of Medical sciences Bangalore, for permitting me to make
use of the college facilities for the present study.
I thank Dr. Gangaboraiah, Professor, Department of Community Medicine,
KIMS for his kind suggestions and support in statistical analysis.
I thank to the entire nursing staff, OT technicians and other staff members of
KIMS Hospital, Bangalore who cooperated with me at all times.
I am greatly indebted to all the patients who participated in this study, without
them this study would not have been possible.
I express my special thanks to my wife Dr. Tanushree and daughter Rucha for
their love and support.

Date:
Place: Dr. Santoshkumar Bennur

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LIST OF ABBREVIATIONS USED
ASA : American society of Anaesthesiologists
AV : Atrio ventricular
BP : Blood pressure
bpm : Beats per minute
BW : Body weight
CNS : Central nervous system
CSF : Cerbro spinal fluid
DBP : Diastolic blood pressure
ECG : Electrocardiogram
Hb : Haemoglobin
HR : Heart rate
i.m. : Intramuscular
Inj. : Injection
i.v. : Intravenous
IPPV : Intermittent Positive Pressure Ventilation
Kg : Kilogram
MAC : Minimum Alveolar Concentration
MAP : Mean arterial pressure
mg : Milligram
min : Minutes
mm Hg : Millimeter of Mercury
μg : Microgram
N2O : Nitrous oxide
O2 : Oxygen
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OT : Operation theatre
SBP : Systolic blood pressure
SD : Standard deviation
SpO2 : Arterial oxygen saturation by pulse oxymeter
RR : Respiratory Rate
LVF: Left ventricular failure

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ABSTRACT
The laryngoscopy and tracheal intubation in adults cause stress response
manifested by a marked haemodynamic changes and autonomic reflex activity
which may be a cause of concern in many high risk patients. Objective of this
study is to know the effects of oral clonidine with respect to heart rate, blood
pressure, attenuation of sympathetic responses to laryngoscopy and intubation,
respiratory rate and undesirable effects.
Methods:-
100 normotensive patients belonging to ASA I status scheduled for elective
surgical procedure were selected randomly and divided into two groups of 50
each. Group I received 4µgmkg-1 oral clonidine and Group II Multivitamin
tablet 90 minutes before induction of anaesthesia. Sedation, Dryness of tongue,
respiratory rate, heart rate, systolic and diastolic pressure and mean arterial
pressure were recorded during premedication and 90 minutes after
premedication. Also the HR, systolic, diastolic blood pressures, MAP were
recorded non-invasively during induction and for the first five minutes following
intubation. Paired and unpaired students T test, and repeated measures ANOVA
test was used for statistical analysis. And undesirable effects and also
complications were looked for.
Results:-
After premedication (90 minutes later) with oral clonidine 4µgmkg-1, sedation,
heart rate, systolic blood pressure, diastolic blood pressure, MAP, respiratory
rate was equally comparable to the placebo group. After intubation, the
incidence of tachycardia was significantly greater in the Placebo group than in
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