Effectiveness of Clonidine and Bromazepam Premedication in Hypertensive Patients Undergoing Spine Fusion Surgery Under General Anaesthesia

Open Access

Abstract

Background: Hypertensive patients undergoing spine fusion surgery are at increased risk of perioperative haemodynamic instability due to exaggerated sympathetic responses. Optimal premedication is essential to improve cardiovascular stability and anaesthetic outcomes. Objective: This study aimed to compare the effectiveness of clonidine and bromazepam as premedication agents in hypertensive patients undergoing spine fusion surgery under general anaesthesia. Methods & Materials: This double-blinded randomised controlled trial enrolled 50 hypertensive patients (ASA II-III) undergoing lumbar spine fusion surgery at Bangladesh Medical University. Patients were randomly assigned to receive either oral bromazepam (Group A, n=25) or oral clonidine (Group B, n=25) 90 minutes before anaesthesia induction. Standardised general anaesthesia was administered. Haemodynamic parameters, anaesthetic drug requirements, intraoperative events, side effects and surgeon satisfaction scores were recorded and analysed using SPSS version 23. A p-value <0.05 was considered statistically significant. Results: Clonidine significantly reduced the requirement of propofol, fentanyl and vecuronium compared with bromazepam (p<0.001). It was associated with fewer hypertensive episodes (0.12 ± 0.33 vs 1.40 ± 1.44, p<0.001) and fewer hypotensive events (0.28 ± 0.61 vs 0.92 ± 1.07, p=0.01). Isoflurane adjustments were also reduced in the clonidine group. Delayed recovery was significantly higher in the bromazepam group (44% vs 8%, p=0.004). Surgeon satisfaction scores were higher with clonidine. Conclusion: Clonidine provides superior haemodynamic stability and improved perioperative outcomes compared with bromazepam in hypertensive patients undergoing spine fusion surgery. It is a more effective premedication strategy in this high-risk population.