CLONIDINE FOR ATTENUATION OF HAEMODYNAMIC

RESPONSE TO ENDOTRACHEAL INTUBATION- A PROSPECTIVE

RANDOMISED COMPARATIVE STUDY

BY

Dr. MAJID MUSHTAQ

Provisional Registration No.201-46141-172-215102

(2017 -2019)
A Dissertation submitted to the National Board of
Examinations ,New Delhi in partial fulfillment of the
requirements for the degree of “Diplomate of National
Board” in the speciality of

ANAESTHESIOLOGY

Under the guidance of

Dr.K.Dilip Kumar ,MD,
Professor,
Department Of Anaesthesiology,
Malla Reddy Narayana Multi Speciality Hospital, Hyderabad.

I
DEDICATED TO MY

PARENTS

II
 CERTIFICATE

This is to certify that the thesis entitled “CLONIDINE FOR ATTENUATION

OF HAEMODYNAMIC RESPONSE TO ENDOTRACHEAL

INTUBATION-A PROSPECTIVE RANDOMISED COMPARATIVE
STUDY” is a bonafide work done by Dr.MAJID MUSHTAQ under my direct
supervision and guidance. The techniques and observations embodied in this
thesis have been checked and verified by me at every stage. The results presented
in this thesis have not been submitted elsewhere for the award of any other degree.

Guide :

Dr. K.DILIP KUMAR, MD

PROFESSOR,
Department of Anaesthesia,
Malla Reddy Narayana Multispeciality Hospital,
Hyderabad .

Place : Hyderabad.

Date:

III
 CERTIFICATE

This is to certify that the thesis entitled “CLONIDINE FOR ATTENUATION

OF HAEMODYNAMIC RESPONSE TO ENDOTRACHEAL

INTUBATION-A PROSPECTIVE RANDOMISED COMPARATIVE
STUDY” is a bonafide work done by Dr.MAJID MUSHTAQ under my direct
supervision and guidance. The techniques and observations embodied in this
thesis have been checked and verified by me at every stage. The results presented
in this thesis have not been submitted elsewhere for the award of any other degree.

Co –Guide:

Dr.Manjula V Ramsli, DNB

Associate Professor,
Department of Anaesthesia.
Malla Reddy Narayana multispeciality Hospital,
Hyderabad.

Place : Hyderabad.

Date:

IV
 CERTIFICATE
This is to certify that the thesis entitled “CLONIDINE FOR
ATTENUATION OF HAEMODYNAMIC RESPONSE TO
ENDOTRACHEAL INTUBATION -A PROSPECTIVE
RANDOMISED COMPARATIVE STUDY” is a bonafide and
genuine research work prepared by Dr.MAJID MUSHTAQ under the
guidance and supervision of Prof. K. Dilip Kumar, Department of
Anaesthesiology in partial fulfillment for the degree of DNB in
Anaesthesiology.

Dr.P.Surender,
Professor and Head of Department ,
Department of Anaesthesiology,
Malla Reddy Narayana Multispeciality Hospital,
Hyderabad.

Place: Hyderabad.

Date:

V
 CERTIFICATE

This is to certify that the thesis entitled “CLONIDINE FOR ATTENUATION OF

HAEMODYNAMIC RESPONSE TO ENDOTRACHEAL INTUBATION - A
PROSPECTIVE RANDOMISED COMPARATIVE STUDY” is a bonafide and genuine
research work done by Dr.Majid Mushtaq in partial fulfillment of the
requirements for the degree of DNB in Anaesthesiology and was carried out in
the Department of Anaesthesiology, Malla Reddy Narayana Multispeciality
Hospital.The cases that have been embodied are the genuine cases of Malla
Reddy Narayna Multispeciality Hospital,Hyderabad.

Dr.K.N.SUDHA RAMANA,
DEAN
Malla Reddy Narayana Multispeciality Hospital,
Hyderabad.

Place : Hyderabad.
Date :

VI
 DECLERATION BY THE CANDIDATE

I, hereby, declare that this thesis entitled “CLONIDINE FOR ATTENUATION OF

HAEMODYNAMIC RESPONSE TO ENDOTRACHEAL INTUBATION - A
PROSPECTIVE RANDOMISED COMPARATIVE STUDY” is a bonafide and genuine
research work carried out by me under the guidance of Dr.K.DILIP KUMAR,
MD,PROFESSOR, Department of Anaesthesiology,Malla Reddy Narayana
Multispeciality Hospital,Hyderabad.

I have not submitted this dissertation to any other university for the award of any
other degree

DR.MAJID MUSHTAQ ,
DNB (secondary) Trainee.

VII
 ACKNOWLEDGEMENT
All praise to Almighty ALLAH ,Lord of the worlds and the
Master of the Day of Judgement .HE blessed me with
patience and strength and by HIS blessings this work was
made possible.
With an immense sense of gratitude ,I thank my esteemed guide,
Dr. K. Dilip Kumar ,Professor Department of Anaesthesiology under
whose supervision and guidance ,I was able to complete this work.
His unsurpassable guidance, meticulous supervision, constant
encouragement, valuable suggestions and critical appreciation in
execution of my work was primarily responsible for making this work
possible.
I sincerely thank my Co-guide Dr.Manjula V Ramsli, Associate
Professor, Department of Anaesthesiology, for her valuable
guidance, keen interest, constant observation and untiring help in
the completion of this project.
I express my deep sense of gratitude to Dr. P.Surender ,Professor and
HOD, Department of Anaesthesiology , for his overwhelming
support ,encouragement and constant inspiration throughout the
study.
I would like to take this opportunity to thank our honourable Dean
Dr.K.Sudha Ramana for providing facilities of par excellence in this
institute which were of an absolute necessity for this project.
I also extend my deep sense of gratitude to Dr.Sharadha Devi
,Professor Department of Anaesthesiology for her valuable
suggestions ,affectionate encouragement ,guidance and never
ending willingness throughout this study.
I sincerely express my humble thanks to Dr.K.Radha Ramana Murthy,
Dr.A.Durga Prasad, Dr.M.Srinivas Reddy,Dr.B.Srinivasulu Reddy,

VIII
Dr.N.Samuel, Dr.Swathi and Dr.Mahesh for their constant support
and encouragement.
I would like to express my heartfelt thanks to Dr.BSKVVG
Malleshwar, Consultant Anaesthesia, for his kind words of wisdom
and encouragement from time to time.
My sincere thanks to Dr.Mohsin Ali and Dr.Sai Divya for their
valuable suggestions and affectionate encouragment throughout
my study.
My sincere thanks to my dear friend Dr.Jehangir Alam Bhat (DNB
Paediatrics) for his timely advice and instructions that have been of
great assistance through out the course of this work.
I would also like to thank my dearest collegues Dr.sujata, Dr.Ramya
and Dr.Rajita for creating such a friendly work atmosphere and their
unending support throughout.
I thank all the faculty of the Department of Anaesthesiology and
Residents for their constant encouragement throughout the study
process.
I am deeply indebted to my grandparents Dr.Ghulam Qadir Dar and
Mehtaba Begum for their blessings, love, care and support .I would
like to mention Late Sheikh Ghulam Rasool and Ateeqa begum
(Grandparents) who bestowed upon me their wishes.
My extreme sense of regards to my adorable parents Dr.(Professor)
Sheikh Mushtaq Ahmed and Mehmooda Akhter for their blessings
teaching ,love and support that I always needed while conducting
this study.
I am extremely grateful and thankful to my wife Afreen jan for her
endurance ,constant support, affectionate encouragement and
every little effort she did for me and loads of love from my lovely
daughter Sarah.

IX
I am grateful to my sister Dr.Farah, my brother Dr.Muzammil and
his wife Ruksana for their best wishes and support.
My humble regards to Er.Abid Hussain for his timely support and
constant help throughout the study.
At last,I extend my thanks to my patients who willingly co operated
with me for this study.

Dr.MAJID MUSHTAQ

X
LIST OF ABBREVIATIONS USED

ASA American Society of Anesthesiologists

HR Heart rate

SBP Systolic blood Pressure

DBP Diastolic blood pressure

MAP Mean Arterial pressure

ANOVA Analysis of Variance

SD Standard deviation

mg milligram

mmHg Millimetres of Mercury

IV Intravenous

GA General Anaesthesia

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 CONTENTS
S. Subject
Page Numbers
No.

I. INTRODUCTION 1 – 25

II. REVIEW OF LITERATURE 26– 36

III. AIMS AND OBJECTIVE 37

IV. MATERIAL AND METHODS 38 – 43

V. RESULTS 44 – 67

VI. DISCUSSION 68-74

VII. SUMMARY 75

VIII. CONCLUSION 76

IX. RECOMMENDATIONS 77

X. BIBLIOGRAPHY 78-85

XI. APPENDIX 86-93

XII
 LIST OF FIGURES
FIG. NO. FIGURES PAGE NO.

a) Surface anatomy of the larynx and surrounding

9
structures.
b) 10
Superior view of the laryngeal introitus.

c) 11
Coronal section through the larynx .

d) 14
Innervation of the larynx .

e) Chemical structure of Clonidine. 20

XIII
 Location of Figures of Results
1 DEMOGRAPHIC PROFILE 44
2 DEMOGRAPHIC PROFILE 44
3 DEMOGRAPHIC PROFILE 44
4 DEMOGRAPHIC PROFILE 44
5 Heart rate changes within Group A (oral clonidine) and Group B (IV 47
clonidine)
6 SBP changes within Group A (oral clonidine) and Group B (IV 50
clonidine)
7 DBP changes within Group A (oral clonidine) and Group B (IV 53
clonidine)
8 MAP changes within Group A (oral clonidine) and Group B (IV 56
clonidine)
9 Heart rate comparison 60
10 Systolic blood pressure comparison 62
11 Diastolic blood pressure comparison 64
12 Mean arterial pressure comparison 66

XIV
 Location of tables of Results

Table Name Page No.

1 DEMOGRAPHIC PROFILE 45
2 Results of repeated measures of ANOVA within the group A 46

3 Results of repeated measures of ANOVA within the group B 46

4 Intra group comparison of heart rates at different time intervals using Tukey- 48
Kramer test in group A (oral clonidine) - Baseline to different time intervals
5 Intra group comparison of heart rates at different time intervals using Tukey- 49
Kramer test in group B (IV clonidine) – Baseline (Pre-Induction) to different
time intervals
6 Intra group comparison of systolic blood pressure at different time intervals 51
using Tukey-Kramer test in group A (oral clonidine) - Baseline to different
time intervals
7 Intra group comparison of Systolic blood pressure at different time intervals 52
using Tukey-Kramer test in group B (IV clonidine) - Baseline to different time
intervals

8 Intra group comparison of diastolic blood pressure at different time intervals 54

using Tukey-Kramer test in group A (oral clonidine) - Baseline to different
time intervals

9 Intra group comparison of diastolic blood pressure at different time intervals 55

using Tukey-Kramer test in group B (IV clonidine) - Baseline to different time
intervals

10 Intra group comparison of mean arterial pressure at different time intervals 57

using Tukey-Kramer test in group A (oral clonidine) - Baseline to different
time intervals

11 Intra group comparison of heart rates at different time intervals using Tukey- 58
Kramer test in group B (IV clonidine ) - Baseline to different time intervals

12 Results of repeated measures of ANOVA in between the two groups 59

13 Inter group comparison of heart rates at different time intervals using 61
Tukey-Kramer test in group A & group B

14 Inter group comparison of SBP at different time intervals using Tukey Kramer 63
test in group A & group B
15 Inter group comparison of DBP at different time intervals using Tukey-Kramer 65
test in group A & group B
16 Inter group comparison of MAP at different time intervals using Tukey-Kramer 67
test in group A & group B

XV