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Evaluate the effect of intravenous clonidine on hemodynamic stress during laparoscopic hysterectomy.

July 12, 2026Open Access

Effect of Intravenous Clonidine Premedication on the Attenuation of Hemodynamic Stress Response in Patients Undergoing Laparoscopic Hysterectomy

ETElambarithy Thangasamy SJSarva Vinothini J

Key Points

Evaluate the effect of intravenous clonidine on hemodynamic stress during laparoscopic hysterectomy.
Prospective randomized double-blind placebo-controlled trial with 90 female patients aged 30-60.
Patients randomly assigned to receive either intravenous clonidine or placebo before surgery.
Hemodynamic parameters measured before, during, and after pneumoperitoneum.
Clonidine group showed significantly lower heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) during pneumoperitoneum (p < 0.05).
In the placebo group, 12 patients experienced hypertension, and eight had tachycardia requiring additional treatment.
Only three patients in the clonidine group developed bradycardia, responding well to atropine.

Abstract

Background Creation of pneumoperitoneum during laparoscopic surgery produces significant hemodynamic changes due to increased intra-abdominal pressure and sympathetic stimulation. Various pharmacological agents have been used to attenuate this stress response. Clonidine, an α2-adrenergic agonist, has sympatholytic properties that may provide hemodynamic stability during surgery. Aim This study aimed to evaluate the efficacy of intravenous clonidine in attenuating the hemodynamic stress response during laparoscopic hysterectomy. Methods This prospective randomized double-blind placebo-controlled trial was conducted on 90 female patients aged 30-60 years with American Society of Anesthesiologists (ASA) physical status I-II undergoing elective laparoscopic hysterectomy. Patients were randomly allocated into two groups of 45 each. Group I received intravenous clonidine 2 mcg/kg diluted in 100 ml normal saline 15 minutes before induction, while Group II received 100 ml normal saline as a placebo. Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were recorded at baseline, after drug administration, post-intubation, during pneumoperitoneum, and after CO₂ release. Results Patients receiving clonidine demonstrated significantly lower HR, SBP, DBP, and MAP during pneumoperitoneum compared with the placebo group (p < 0.05). In the placebo group, 12 patients developed hypertension, and eight patients developed tachycardia requiring nitroglycerine infusion and fentanyl administration. In the clonidine group, only three patients developed bradycardia, which responded to atropine. No significant postoperative sedation or nausea and vomiting were observed. Conclusion Intravenous clonidine 2 mcg/kg administered 15 minutes before induction effectively attenuates the hemodynamic stress response to pneumoperitoneum during laparoscopic hysterectomy without significant adverse effects.

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