Oral clonidine premedication for elderly patients undergoing intraocular surgery

In a randomized double-blind study, the effects of clonidine premedication as a sedative, anxiolytic, analgesic and oculohypotensive agent were studied in 100 elderly patients (62 to 65 ± 10 years, ASA grade I–II) undergoing elective intraocular surgery under local anaesthesia. The control group (Group A, n = 50) received oral diazepam 0.15 mg/kg 120 min before surgery and Group B (n = 50) received oral clonidine 300 μg 120 min before surgery. Two hours after the premedication, there was significantly more sedation (P<0.05) and less subjective anxiety (P<0.05) in the clonidine group than in the control group. There was a significant fall in intraocular pressure (IOP) from 20 ± 0.5 to 13 ± 0.5 mmHg (P<0.05) and significant reduction in systolic and diastolic blood pressure (BP) and heart rate (HR) (P<0.05) in the clonidine group as compared to the control group. Perioperatively, significantly more supplementation with i.v. diazepam was given in the control group than in the clonidine group (P<0.01). The incidence of intra-operative hypertension (P<0.01) and tachycardia (P<0.05) was significantly greater in the control group than in the clonidine group. A significantly larger number of patients in the clonidine group scored a Post-Anaesthesia Recovery (PAR) score of 10 as compared to the control group (P<0.01). There was no statistical difference in the postoperative Visual Analogue Scale (VAS) scores for pain, number of analgesic requests and emesis. Hence premedication with oral clonidine in these elderly patients undergoing elective intraocular surgery produced intraoperative sedation, reduction in anxiety and decrease in intraocular pressure. Postoperative recovery was improved in the clonidine group.