Evaluate the efficacy of Intravenous Clonidine and Dexmedetomidine on Haemodynamic stress response during Pneumoperitoneum in Laparoscopic Cholecystectomy Surgeries

Abstract

Background: This study is designed to compare the beneficial effect of the two  α- 2 agonists namely clonidine and dexmedetomidine in maintaining the perioperative haemodynamic parameters such as systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP), heart rate (HR) during pneumoperitoneum in laparoscopic cholecystectomy and to identify a better drug in attenuating these haemodynamic responses.

Methodology: The study group included ninety ASA grade I and II patients, aged between 20 to 50 years, belonging to either sex, scheduled for elective laparoscopic cholecystectomy under general anesthesia in the operation room of the institute.

Group A (n=30) received 50 ml normal saline over a period of 10 minutes after induction and before pneumoperitoneum (PNP), followed by a continuous slow infusion  at the rate of 0.5 ml/kg/hr. Group B (n=30) Clonidine 2µg/kg in 50ml normal saline over a period of 10 minutes after induction and before PNP, followed by a continuous infusion at the rate of 0.5 ml/kg/hr( 2 µg/kg/hr). Group C (n=30) Clonidine 2µg/kg in 50ml normal saline over a period of 10 minutes after induction and before PNP, followed by a continuous infusion at the rate of 0.5 ml/kg/hr( 2 µg/kg/hr).

Results: Rise in heart rate were statistically insignificant in all the groups at baseline(B) and just after induction (D0). After infusion of drugs,rise in heart rate were significantly lower in all the intervals in Clonidine group and Dexmedetomidine group comparing with Control group. While comparing Clonidine with Dexmedetomidine,significantly lower heart rate were observed in dexmedetomidine group. On inter-group statistical analysis statistically significant decrease in SBP, DBP and MAP were observed at all the intervals in clonidine and dexmedetomidine group except at baseline (B),( D0 ) on comparison with Control group.While comparing Dexmedetomidine group with clonidine group, insignificant decrease (p>0.05) in SBP and MAP were observed at all intervals except at 50 minutes after pneumoperitoneum ( APN50) . On comparing dexmedetomidine group with clonidine group,insignificant decrease (p>0.05) in DBP were observed at all intervals except at 30 minutes after pneumoperitoneum ( APN30) and after reversal(DBP_AR).On inter-group statistical analysis of sedation score after extubation, there was significantly higher sedation (score3 and 4) (p<0.05) seen in Dexmedetomidine group on comparing with Control group and Clonidine group,whereas on comparing Clonidine group with Control group higher sedation was observed in Clonidine group.

Conclusion: Creation of pneumoperitoneum in laparoscopic abdominal surgeries produces significant increase of heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and mean arterial pressure (MAP). Both intravenous clonidine and intravenous dexmedetomidine cause decrease in all haemodynamic parameters (HR, SBP, DBP and MAP) during pneumoperitoneum in laparoscopic abdominal surgeries. Dexmedetomidine and clonidine are equally effective in controlling blood pressure during pneumoperitoneum in laparoscopic surgeries but heart rate is better controlled by dexmedetomidine.