Clin Exp Otorhinolaryngol.  2014 Dec;7(4):307-311. 10.3342/ceo.2014.7.4.307.

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

• Wawrzyniak K
• Kusza K
• Cywinski J

• KMID: 2278372
• DOI: http://doi.org/10.3342/ceo.2014.7.4.307

Abstract

OBJECTIVES
Premedication 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.
METHODS
Forty-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.
RESULTS
Total intraoperative remifentanil requirement was lower in the clonidine group as compared to the midazolam group 503.2+/-147.0 microg vs. 784.5+/-283.8 microg, 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.
CONCLUSION
Premedication 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.

Keyword

Anesthesia; Surgical procedures; Minimally invasive; Clonidine; Premedication

MeSH Terms

Anesthesia
Anesthesia, Intravenous
Anxiety
Blood Pressure
Clonidine*
Heart Rate
Hemodynamics
Hemorrhage
Humans
Midazolam*
Pain, Postoperative
Polyps
Premedication*
Propofol
Shivering
Sinusitis
Clonidine
Midazolam
Propofol

Figure

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  Fig. 1 Comparison of premedication choice (clonidine vs. midazolam) on hemodynamic parameters during procedure. Heart rate (HR), systolic blood pressure (SAP), diastolic blood pressure (DAP), mean arterial pressure (MAP) in admission to the operating room (SAP1, DAP1, MAP1, HR1), after induction of anesthesia (SAP2, DAP2, MAP2, HR2) during endotracheal intubation (SAP3, DAP3, MAP3, HR3) and extubation (SAP4, DAP4, MAP4, HR4).

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