Direct laryngoscopy and endotracheal intubation act as powerful noxious stimuli causing stimulation of sympathetic nervous system. Hence the present study intended to evaluate and compare the role of oral melatonin and clonidine as premedication in attenuation of this hemodynamic response.

A Prospective, randomized, double blinded, placebo-controlled study. A total of 120 participants, ASAI/II, belonging to age group 18–60 years, were selected in study, equally divided into three groups: Group M (Melatonin 6 mg), Group C (Clonidine 0.2 mg), and Group P (Placebo). The drugs were given 60 min prior to induction of general anesthesia. Vital parameters like HR, SBP, DBP, MAP, and RPP (rate pressure product) were recorded before study drug administration (baseline), 30 min after drug administration, before induction, before intubation, immediately after intubation (0 min); 1, 2, 3, 5, and 10 min after intubation. P value < 0.05 was considered significant.

A total of 115 participants were included in the study, out of which 35 were in Group M, 40 in Group C, and 40 in Group P. 21(18.3 %) were males and 94(81.7 %) were females. The mean values were much lower in Group M and Group C as compared to Group P terms of HR, SBP, DBP, and RPP at the following timepoints: before intubation, 0,1,2,3,5,10 min after intubation (p < 0.05).

Both oral melatonin and clonidine are excellent drugs as premedication for attenuation of hemodynamic response to direct laryngoscopy and endotracheal intubation. Also, there is much lesser need for intraoperative rescue propofol doses and antihypertensives.