Surgical procedures and anaesthesia induce substantial physiological strain on the body. This stress frequently stimulates the sympathetic nervous system, leading to accelerated heart rate, higher blood pressure, and vasoconstriction (narrowing) of peripheral blood vessels.17 These responses can result in several clinical challenges, including increased intraoperative blood loss, impaired visibility for surgeons at the operating site, and a prolonged postoperative recovery period. Therefore, the use of medications to control how the cardiovascular system responds has grown to be a key element of modern anaesthesia. The α₂-adrenergic agonist clonidine achieves its effect by inhibiting the central nervous system's sympathetic activity, which in turn reduces the amount of norepinephrine in the plasma. These results in lower heart rate mean arterial pressure, and systemic vascular resistance.13 Many studies have shown that clonidine enhances stability in blood flow during an operation and lessens bleeding, which notably improves how clearly the surgeon can see, especially in ear, nose, and throat (otorhinolaryngological) procedures and keyhole (laparoscopic) surgeries. Its ability to keep conditions stable during surgery and cut down on blood loss has been thoroughly supported by past research. Along with how it affects blood flow, clonidine also helps patients relax and allows for less reliance on stronger pain medications (opioids), making the recovery from anaesthesia easier, requiring less anaesthetic overall, and increasing comfort after the operation6. Metoprolol, a specific beta-1 blocker, lowers heart rate and the force of heart muscle contraction, thereby lessening the heart's need for oxygen. This medication is widely used for individuals who have heart problems like ischemic heart disease and arrhythmias. Large-scale clinical research indicates that metoprolol given during the period surrounding non-cardiac surgery may decrease the likelihood of a heart attack; however, these benefits might be counteracted by adverse effects, including low blood pressure during the operation and a slow heart rate, which could result in further complications after surgery.14 Research, such as the MaVS trial, confirms its efficacy in managing heart rate, but safety issues remain due to worries about blood pressure drops during surgery and rapid heart rate upon withdrawal.3 These safety concerns have revitalized the interest in clonidine, a drug that may provide comparable blood pressure management with a potentially safer profile.10 Clonidine offers distinct therapeutic advantages during surgery, primarily through its ability to lessen blood loss and improve the clarity of the surgical site. By decreasing nerve signals that narrow blood vessels, it causes vasodilatation, resulting in less capillary bleeding. This effect is especially useful in minimally invasive operations, including procedures performed using an endoscope or laparoscope, where a clear view is crucial. Furthermore, the sedative properties of clonidine bolster its anaesthetic-sparing benefits, thus promoting more stable conditions during surgery. However, metoprolol efficacy in heart rate control does not translate to improved operative visibility or reduced anaesthetic requirements, thus limiting its application in procedures where a clear surgical field and minimal bleeding are paramount.19˒4,7 After an operation, clonidine maintains its efficacy, helping to dampen excessive nerve activity, decrease the chance of blood pressure resurgence, and minimize the necessity for analgesic drugs. Its intrinsic calming effects also aid in a more peaceful recuperation while diminishing the reliance on further medicines.7 Metoprolol effectively manages heart rate, but because it provides no pain or anxiety relief, it falls short of fully addressing postoperative discomfort and stress, commonly requiring extra medication. Although there is encouraging evidence, the existing research exhibits a lack of consistency in methodology and findings, which hinders a direct comparison between the two agents.16 Consequently, this prospective, randomized controlled trial was carried out to assess the perioperative effectiveness of premedication with oral clonidine (0.15 mg) and metoprolol (50 mg) in patients undergoing laparoscopic cholecystectomy under general anaesthesia. The study's primary focus was on intraoperative hemodynamic stability, blood loss, and the quality of the surgical field, in addition to postoperative outcomes like pain levels, recovery duration, and the length of hospital stay.18

This research was conducted over a period of 15 months and enrolled participants between the ages of 18 and 60. The participants were all adults scheduled to undergo elective surgeries that necessitated the use of general anaesthesia. Each individual was required to have an American Society of Anaesthesiologists (ASA) physical status score of I or II, indicating they were generally healthy or had mild systemic disease, respectively. To establish the required number of participants, a power analysis was conducted, drawing on existing literature that contrasted intraoperative blood loss between patients administered clonidine versus metoprolol. Assuming a 15 ml average difference in blood loss and a standard deviation of 18 ml, an effect size of 0.8 was computed. Based on these figures, an 80% statistical power and a two-sided 0.05 alpha level indicated a minimum requirement of 26 participants per group. To accommodate potential participant attrition and maintain statistical robustness, 60 individuals were enrolled and randomly assigned to one of two 30-person groups: Group A (clonidine) or Group B (metoprolol). Allocation to treatment groups was determined via a computer-generated block technique, and blinding was preserved by using sealed, opaque envelopes opened only when the medication was administered. The study employed a double-blind design, ensuring both participants and data collectors were unaware of group assignments. The team handling preoperative drug administration had no role in the subsequent observations or evaluations. All participants were directed to fast from the previous evening before their operation. On the day of surgery, two hours prior to the scheduled procedure, patients were given premedication. Group A was given 0.15 mg of clonidine orally along with 30 ml of water, while Group B received 50 mg of metoprolol orally with 30 ml of water. Furthermore, as a component of the standard premedication regimen, every patient was administered intravenous glycopyrrolate (0.2 mg) and ondansetron (8 mg) before the induction of anaesthesia. Continuous surveillance was performed during the operation, utilizing electrocardiogram (EKG), non-invasive blood pressure assessments, and pulse oximetry to monitor the patient's vital signs. . Before any anaesthetic agents were given, initial (baseline) measurements were taken. Anaesthesia was initiated by intravenously administering fentanyl (2 mcg/kg), propofol (2 mg/kg), and vecuronium (0.1 mg/kg) to allow a breathing tube to be placed in the windpipe. "Anaesthesia was maintained using a gaseous mixture composed of 66% nitrous oxide and 33% oxygen, with isoflurane concentrations calibrated within the range of 0.8% to 1.0%. Ringer’s lactate solution was administered via an IV drip at an initial rate of 10 mL/kg/hour for the first hour, subsequently decreased to 5 ml/kg/hour. Vitals, including heart rate, Hemodynamic parameters, encompassing systolic and diastolic arterial pressure, respiration rate, and peripheral capillary oxygen saturation, were documented at the study's inception, just after the administration of anaesthesia, and at 0, 20, 60, 120, and 180 minutes throughout the surgical procedure. Concurrently, intraoperative blood loss was quantified via a validated haemoglobin-based technique. To counteract coagulation, heparin (at a concentration of 1:250,000) was introduced into the surgical suction canister before the operation began. The aggregate volume within the suction apparatus was recorded, and the extent of blood loss was ascertained by utilizing the patient's mean haemoglobin level and the haemoglobin concentration identified in the collected contents, adhering to established methodological guidelines. . The operating surgeon independently evaluated the surgical site using the Average Category Scale (ACS), a tool originally proposed by Fromme et al. and subsequently modified by Boezaart et al. for use in endoscopic procedures. The ACS classifies the degree of bleeding and visibility into three categories: "good" (grades 0–1; requiring minimal or no suction), "fair" (grades 2–3; necessitating intermittent suction), and "poor" (grades 4–5; where significant bleeding mandates continuous suction) Post-surgery assessments included the length of the recovery period, the intensity of pain via the Visual Analog Scale (VAS), how often nausea occurred, the requirement for postoperative pain medication, and the time until the initial dose of analgesic was given. A backup pain reliever of 1 gram of intravenous paracetamol was administered if the VAS score was 4 or higher (≥4). Data were analyzed using EPI Info version 7.2. Continuous variables were checked for normal distribution and analyzed using the independent samples t-test or the Mann–Whitney U test, as appropriate, while categorical variables were evaluated with the chi-square test or Yates-corrected Chi-square test. A p-value of less than 0.05 (p < 0.05) indicated statistical significance

A randomized, controlled clinical trial, including 60 adult patients undergoing elective general anesthesia surgery, sought to evaluate the perioperative impacts of administering either 0.15 mg of oral clonidine or 50 mg of oral metoprolol on the stability of hemodynamic, blood loss during surgery, and recovery after the operation. The study subjects were assigned randomly and equally to two cohorts: Group A was administered clonidine (n = 30), and Group B was given metoprolol (n = 30). This investigation systematically assessed how well these two drugs work in preserving cardiovascular stability during the operation and enhancing post-operative recovery. The participants had comparable demographic and initial health metrics across both the clonidine (Group A) and metoprolol (Group B) groups, which are further specified in Table 1. Baseline demographics and clinical characteristics, such as mean age, gender, ASA classification, height, weight, and all tested preoperative laboratory values (haemoglobin, blood sugar, serum creatinine, electrolytes), did not differ significantly between the groups (P > 0.05). These equivalent baseline conditions validate the randomization and support the integrity of subsequent comparisons regarding perioperative outcomes. Intraoperative vital signs remained stable throughout the surgical period across both groups. Hemodynamic and respiratory values, including heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, and oxygen saturation, were observed at predefined points: preoperatively, immediately post-induction, and at intervals up to 180 minutes. Patients in Group A (clonidine) and Group B (metoprolol) maintained these parameters within a stable range during surgery. (Table 2, Figure 1). Both Clonidine and Metoprolol achieved comparable hemodynamic and respiratory stability throughout the study, with no meaningful statistical discrepancies observed between the groups (P > 0.05). Both agents were associated with a similar, gradual decline in heart rate and blood pressure, without clinically important differences emerging. These results indicate that both medications are effective in maintaining cardiovascular control during surgery. Furthermore, respiratory function was consistent and stable across all participants, with oxygen saturation levels consistently exceeding 98%, confirming the safety and efficacy of both drugs in ensuring proper oxygenation during the perioperative period. Table 1: Socio-demographic and clinical variables of the sample population. Parameter Group A (Clonidine) (N = 30) * Group B (Metoprolol) (N = 30) * P-value Mean Age (years) 36.57 ± 12.52 35.56 ± 10.35 0.6785 Gender (Female / Male) 22 / 8 (73.33% / 26.67%) 25 / 5 (83.33% / 16.67%) 0.356 ASA Grade I / II 25 / 5 (83.33% / 16.67%) 25 / 5 (83.33% / 16.67%) >0.05 Height (cm) 157.09 ± 7.32 156.31 ± 7.79 0.9941 Weight (kg) 60.71 ± 9.88 58.39 ± 9.42 0.1185 Preoperative Haemoglobin (g%) 12.21 ± 2.13 12.19 ± 2.31 0.922 Random Blood Sugar (mg/dL) 97.7 ± 13.92 99.5 ± 14.58 0.523 Serum Creatinine (mg/dL) 0.79 ± 0.92 0.93 ± 0.19 0.617 Serum Sodium (mEq/L) 139.88 ± 3.75 138.82 ± 3.67 0.752 Serum Potassium (mEq/L) 4.25 ± 0.38 4.35 ± 0.21 0.644 ECG Normal / Abnormal 27 / 3 (90% / 10%) 28 / 2 (93.33% / 6.67%) 0.482 Chest X-ray Normal / Abnormal 28 / 2 (93.33% / 6.67%) 29 / 1 (96.67% / 3.33%) 0.395 Data are presented as mean ± standard deviation (SD) or number (%). The summary table illustrates the high degree of similarity between the two study groups regarding their key demographic and initial clinical characteristics. The average age of participants was nearly identical across both groups; Group A (clonidine) averaged 36.57 ± 12.52 years old, while Group B (metoprolol) averaged 35.56 ± 10.35 years old. The groups exhibited similar proportions regarding sex distribution and ASA grade. Additionally, there were no significant disparities in anthropometric measurements, like height and weight, nor in preoperative laboratory values, including haemoglobin, random blood sugar, serum creatinine, sodium, and potassium levels. The incidence of typical versus atypical ECG and chest X-ray findings was equally proportioned between the two cohorts. These findings suggest that the two groups exhibited similar baseline characteristics, establishing a consistent basis for comparing their subsequent outcomes. Intraoperative, mean heart rate for the clonidine group (Group A) exhibited a gradual reduction, moving from a baseline of 83.32 ± 12.54 bpm to 80.94 ± 12.44 bpm by the 180-minute mark. Within Group B (metoprolol), heart rate declined from 79.44 ± 14.47 bpm to 77.56 ± 15.63 bpm, indicating stable cardiac control across both cohorts. Systolic blood pressure (SBP) was reduced from 126.44 ± 13.35 mmHg to 105.66 ± 18.06 mmHg in Group A, while Group B saw a decrease from 120.61 ± 13.28 mmHg to 99.78 ± 10.60 mmHg. Concurrently, diastolic blood pressure (DBP) fell from 75.95 ± 10.94 mmHg to 62.23 ± 16.71 mmHg in Group A and from 73.61 ± 10.01 mmHg to 57.96 ± 13.39 mmHg in Group B.The respiratory rate (RR) was maintained within the expected parameters; the values in Group A varied between 15.06 ± 2.19 and 17.39 ± 1.17 breaths per minute, while those in Group B shifted from 18.38 ± 2.06 to 14.67 ± 1.30 breaths per minute. Oxygen saturation (SpO₂) levels consistently remained within a healthy range, with Group A exhibiting values between 96.47 ± 0.62% and 98.51 ± 0.93%, and Group B showing levels from 96.53 ± 2.00% to 99.84 ± 1.95%. These results underscore adequate respiratory function and sustained oxygenation throughout the observation period. Table 3: Haemoglobin and blood loss indicators Parameter Group A (Clonidine)* Group B (Metoprolol)* p-value Preoperative Haemoglobin (g%) 12.19 ± 2.61 11.33 ± 2.02 0.922 Postoperative Haemoglobin (g%) 11.26 ± 2.24 11.04 ± 2.05 0.3995 Mean Haemoglobin (g%) 11.33 ± 2.30 11.17 ± 2.13 0.425 Haemoglobin in Canister (g%) 8.09 ± 1.65 7.27 ± 1.86 0.292 Suction Volume (ml) 211.49 ± 35.70 234.60 ± 29.24 0.0011 Blood Loss (ml) 140.94 ± 15.70 169.07 ± 8.13 0.0002 Haematocrit Preop (%) 34.81 ± 2.95 35.16 ± 2.89 0.521 Haematocrit Postop (%) 31.93 ± 3.05 32.71 ± 2.95 0.486 Estimated Blood Loss Adjusted for Haematocrit (ml) 142.37 ± 12.93 163.29 ± 11.67 0.038 Table 2: Circulatory and pulmonary function: Group A: Clonidine (N = 30), Group B: Metoprolol (N = 30) Time Point (min) HR (bpm) Group A HR (bpm) Group B SBP (mmHg) Group A SBP (mmHg) Group B DBP (mmHg) Group A DBP (mmHg) Group B RR (breaths/min) Group A RR (breaths/min) Group B SpO₂ (%) Group A SpO₂ (%) Group B Preoperative 83.32 ± 12.54 79.44 ± 14.47 126.44 ± 13.35 120.61 ± 13.28 75.95 ± 10.94 73.61 ± 10.01 15.06 ± 2.19 18.38 ± 2.06 96.83 ± 0.25 97.48 ± 0.74 0 85.07 ± 13.84 80.20 ± 11.83 116.90 ± 14.90 109.40 ± 15.74 74.44 ± 12.07 71.99 ± 10.20 17.62 ± 1.67 17.10 ± 0.58 96.48 ± 0.00 99.84 ± 1.95 5 82.53 ± 15.33 80.56 ± 11.92 117.08 ± 19.61 104.98 ± 11.68 69.91 ± 13.08 68.66 ± 12.68 16.11 ± 1.16 15.75 ± 1.55 98.33 ± 1.85 96.53 ± 2.00 10 83.09 ± 12.21 80.75 ± 13.56 112.22 ± 18.39 103.82 ± 8.99 65.47 ± 15.77 66.88 ± 12.53 17.18 ± 2.09 14.48 ± 2.23 97.43 ± 1.55 97.92 ± 0.89 15 84.77 ± 10.58 80.07 ± 15.68 115.31 ± 19.85 110.00 ± 17.50 68.97 ± 15.27 64.84 ± 13.94 17.39 ± 1.01 14.14 ± 1.89 97.06 ± 2.19 99.65 ± 0.09 20 87.03 ± 12.16 80.08 ± 14.18 112.12 ± 16.51 106.73 ± 14.46 66.12 ± 14.15 64.78 ± 13.21 16.59 ± 1.41 16.09 ± 1.15 97.29 ± 0.34 98.31 ± 1.10 60 80.05 ± 11.29 77.16 ± 16.04 104.40 ± 18.56 99.52 ± 11.58 59.25 ± 13.98 60.52 ± 15.07 17.39 ± 1.17 14.91 ± 1.50 98.51 ± 0.93 98.11 ± 1.46 120 85.18 ± 12.38 80.54 ± 12.29 126.73 ± 14.09 122.00 ± 10.74 77.04 ± 10.46 74.81 ± 11.84 17.09 ± 1.53 14.67 ± 1.30 96.47 ± 0.62 97.08 ± 0.71 180 80.94 ± 12.44 77.56 ± 15.63 105.66 ± 18.06 99.78 ± 10.60 62.23 ± 16.71 57.96 ± 13.39 16.07 ± 1.72 16.66 ± 1.59 98.39 ± 1.03 97.05 ± 1.08 Prior to the operation, haemoglobin concentrations were virtually equivalent between the clonidine (12.19 ± 2.61 g/dL) and metoprolol (11.33 ± 2.02 g/dL) cohorts; following the procedure, levels declined marginally to 11.26 ± 2.24 g/dL and 11.04 ± 2.05 g/dL, respectively. Patients administered clonidine exhibited significantly reduced suction volumes and total blood loss (211.49 ± 35.70 ml and 140.94 ± 15.70 ml) compared to those receiving metoprolol (234.60 ± 29.24 ml and 169.07 ± 8.13 ml), supported by p-values of 0.0011 and 0.0002. Although pre- and postoperative hematocrit levels remained comparable between groups, clonidine demonstrated superior blood conservation after adjusting for hematocrit, with an estimated blood loss of 142.37 ± 12.93 ml versus 163.29 ± 11.67 ml for metoprolol (p = 0.038). Table 4: Surgical field quality assessment (ACS grading) ACS Grade Group A (Clonidine) * Group B (Metoprolol) * p-value Good (ACS 0-1) 19 (63.33%) 15 (50%) 0.041 Fair (ACS 2-3) 10 (33.33%) 11 (36.67%) - Poor (ACS 4-5) 1 (3.33%) 4 (13.33%) - A substantial difference was found between the two groups during the assessment of the surgical field's quality using ACS grading. In Group A, good surgical field quality (ACS 0-1) was observed in 63.33% of patients who were given clonidine, while in Group B, this outcome was noted in 50% of patients receiving metoprolol; the difference between the two groups was statistically significant (p=0.041). The findings indicated that acceptable quality (ACS 2-3) represented 33.33% of the studies for clonidine and 36.67% for metoprolol. Conversely, subpar quality (ACS 4-5) was reported more frequently for Group B subjects (13.33%) than for Group A subjects (3.33%). The findings suggest that clonidine could provide better surgical field quality relative to metoprolol during operative procedures. Statistical analysis revealed that the Clonidine and Metoprolol groups exhibited comparable intraoperative hemodynamic stability, showing no notable discrepancies in heart rate, systolic and diastolic blood pressure, respiratory rate, or oxygen saturation, as all p-values exceeded 0.05. . Variations in heart rate and blood pressure, along with occurrences of events like drops in blood pressure, increases in heart rate, alterations in breathing, and reductions in oxygen saturation, were also comparable across the groups, indicating similar safety during surgery. These results establish that both agents are effective at sustaining consistent cardiovascular and respiratory parameters without major shifts in blood flow dynamics. Both groups exhibited comparable intraoperative stability, as evidenced by the maintenance of stable hemodynamic parameters without significant differences in heart rate, blood pressure, respiratory rate, or oxygen saturation. The similar event frequencies and variability measures between the groups further support this finding. Subgroup analyses across age, sex, and ASA grades also showed no meaningful distinctions, suggesting that Clonidine and Metoprolol provide equivalent hemodynamic control. The two groups exhibited comparable postoperative outcomes, with no statistically significant differences observed across key recovery metrics such as recovery times, pain levels, nausea, length of hospital stay, and analgesic requirements. Consequently, Clonidine and Metoprolol appear to offer similar benefits, and neither demonstrated a clear clinical advantage over the other. Table 7: Analysis of postoperative outcomes Outcome Group A (Clonidine) * Group B (Metoprolol) * Statistical Analysis p-value Recovery Time (mins) 43.8 ± 11.0 48.7 ± 9.4 T-test 0.48 Pain Score (VAS 0-10) 3.5 ± 1.2 3.9 ± 0.9 Mann-Whitney U 0.38 Postoperative Nausea (%) 12% 14% Chi-square test 0.72 Length of Hospital Stay (days) 2.0 ± 0.5 2.1 ± 0.5 T-test 0.55 Postoperative analgesic requirement (mg) 78.9 ± 11.9 86.3 ± 13.5 T-test 0.42 Time to First Analgesia (hrs) 4.5 ± 1.7 3.4 ± 1.5 T-test 0.47 TabLe 5: Hemodynamic stability and time-to-event analysis Parameter / Time Group A (Clonidine)* Group B (Metoprolol)* p-value Heart Rate (F-Statistic) 1.82 1.56 0.14 Systolic Blood Pressure (F-Statistic) 0.98 0.86 0.22 Diastolic Blood Pressure (F-Statistic) 0.94 0.95 0.34 Respiratory Rate (F-Statistic) 0.91 0.98 0.21 Oxygen Saturation (F-Statistic) 0.53 0.84 0.42 Preop Correlation (HR & BP) 0.55 0.38 0.67 0 min Correlation 0.52 0.67 0.62 10 mins Correlation 0.80 0.41 0.59 30 mins Correlation 0.59 0.31 0.64 120 mins Correlation 0.67 0.29 0.73 Heart Rate Variability (CV) 0.19 0.21 0.31 Systolic BP Variability (CV) 0.28 0.10 0.27 Diastolic BP Variability (CV) 0.29 0.12 0.34 BP Drop (>20% from Baseline) 4 events 8 events 0.42 Heart Rate Spike (>20 bpm) 4 events 4 events 0.55 Respiratory Rate Change 3 events 1 events 1.00 Oxygen Saturation Drop (<95%) 2 events 2 events 1.00 Table 6: Subgroup analysis by demographics Subgroup Parameter Group A (Clonidine) * Group B (Metoprolol) * p-value Age < 40 Heart Rate (beats/min) 84.9 ± 11.0 80.8 ± 13.1 0.15 Systolic BP (mmHg) 122.5 ± 12.8 120.7 ± 13.5 0.18 Age ≥ 40 Heart Rate (beats/min) 87.0 ± 12.5 82.4 ± 12.9 0.22 Systolic BP (mmHg) 125.3 ± 14.7 121.6 ± 12.7 0.16 Gender: Male Heart Rate (beats/min) 80.9 ± 10.1 82.7 ± 14.2 0.33 Gender: Female Heart Rate (beats/min) 83.7 ± 13.6 80.3 ± 14.3 0.21 ASA Grade I Systolic BP (mmHg) 124.4 ± 14.2 119.0 ± 13.8 0.24 ASA Grade II Systolic BP (mmHg) 123.1 ± 15.1 122.3 ± 14.7 0.26

This randomized controlled trial provides valuable clinical insights into the use of oral Clonidine and Metoprolol as premedication for laparoscopic cholecystectomy.8 The study found both medications to be equally effective at maintaining stable hemodynamic during surgery, observing no significant differences in heart rate, blood pressure, or oxygen saturation. This outcome aligns with existing literature, which highlights the ability of these agents to mitigate sympathetic responses during surgical procedures.2 Nevertheless, Clonidine demonstrated a notable advantage by significantly reducing blood loss and improving the visibility of the surgical field. This benefit is likely due to its central sympatholytic action, which decreases catecholamine release and systemic vascular resistance, thus minimizing capillary bleeding and enhancing surgical conditions.5,20 Both drugs demonstrate comparable safety and tolerability profiles, as indicated by similar levels of postoperative pain, recovery times, and hospital stays, without negatively affecting the recovery process.11 Clonidine offers the added benefits of sedation and reduced opioid requirements, which could lead to a less agitated emergence from anaesthesia; however, the study found no difference between the groups regarding the need for pain medication and the incidence of nausea.12 Metoprolol is especially useful for controlling heart rate in individuals with cardiovascular problems, but it lacks the advantages of blood conservation and reduced anaesthetic requirements offered by clonidine. This allows for tailored medication selection depending on the specific surgical situation and the patient's individual health profile.9 While some studies have shown variability, this trial strongly supports using clonidine as the optimal premedication for laparoscopic surgeries that need the best surgical field conditions and excellent blood management.15 Improved surgical field visualization enhances accuracy and reduces operating time; with the addition of clonidine’s stable hemodynamic effects, it becomes a preferred option in this setting. Although further large-scale studies are needed to fully elucidate long-term results and safety data, the current data provides persuasive proof that Clonidine should be routinely used instead of Metoprolol for patients having laparoscopic cholecystectomy.1

While both oral clonidine and metoprolol effectively maintain hemodynamic stability during surgery and aid in postoperative recovery from laparoscopic cholecystectomy, clonidine provides a unique advantage by markedly reducing blood loss and enhancing the quality of the surgical field, positioning it as the preferred agent for operations demanding clear visibility and minimal bleeding. CONFLICTS OF INTEREST: None

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