A Comparison of oral Clonidine versus oral Diazepam premedication for maintaining haemodynamic stability during craniotomy

Background: Clonidine is an alpha-2 adrenergic agonist, which is a centrally acting antihypertensive drug. The recent reviews had shown that clonidine has sedative, anxiolytic, analgesic, and anesthetic-sparing properties which would stabilises the circulatory system and maintains the perioperative stress response at a lower level. Aim: To compare the efficacy between oral clonidine and oral diazepam as a premedication in maintaining the hemodynamic stability during craniotomy surgeries. Materials and Methods: Fifty patients with various types of intracranial tumours who were planned for elective surgical excision were included for the study. Group 1 patients (n=25) received 0.2mg/kg of diazepam and the Group 2 patients received 3.5mcg/kg body weight of clonidine orally 90mts before induction. Recordings of systolic, diastolic, mean blood pressure and heart rate was done from the arterial tracing, the transducer kept at the level of the external auditory meatus. It was made every 10mts for the first 2hours from the time of dural opening. Results: Of all the various hemodynamic parameters the heart rate alone had shown a statistically significant reduction over the period of 2 hours in patients among the clonidine group. The blood pressure parameters in both the groups had also shown reduction from base line in the first 60minutes and later on over the period of 2 hours the values had come back to that of the base line values and no statistically significant difference had occurred between the two groups and also the antisialagogue activity is more with clonidine than   diazepam. Conclusion: The hemodynamic response during craniotomy was better controlled with clonidine which has shown a better response in controlling tachycardia and maintaining the systolic, diastolic and mean arterial pressures than diazepam. So clonidine can be considered as a good drug for premedication in craniotomy surgeries in comparison with diazepam. Keywords: Clonidine, Diazepam, Hemodyn