DOI: http://dx.doi.org/10.18203/2349-3933.ijam20172273

Intravenous clonidine for suppression of haemodynamic response to laparoscopy- a prospective randomised, placebo controlled, single centre study

Pradnya M. Bhalerao, Shalini K. Thombre, Upendra S. Kapse, Kunal V. Targe

Abstract


Background: Laparoscopic surgeries, including cholecystectomy are being performed on a large scale owing to the improved tissue healing and minimal hospital stay. However the haemodynamic response to pneumoperitoneum could pose a problem in these patients. The primary objective of this study was to evaluate the effectiveness of 1µg/kg intravenous clonidine in suppression of this hemodynamic response. The secondary objective was to assess the postoperative analgesia and sedation.

Methods: 60 patients posted for laparoscopic cholecystectomy were divided into two groups. 30 patients received intravenous midazolam 0.03mg/kg and pentazocine 0.3mg/kg and the other 30 received intravenous clonidine 1µg/kg 15 minutes prior induction.

Results: Intraoperative mean pulse rate was 90.82±4.81 beats per minute in control group. In clonidine group it was 74.76±9.88 beats per minute (p<0.05 significant). Similarly the mean systolic blood pressure was 137.87±4.89 and 125.79±6.44 respectively (p<0.05-significant). The duration of postoperative analgesia was 334.83±24.65 and 116.05±19.17 minutes respectively (p<0.05).

Conclusions: Premedication with intravenous clonidine, has been found to be relatively safe as well as an effective method that provides stable haemodynamics and protection against stress response induced by pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.


Keywords


Clonidine, neuroendocrine response, laparoscopy

Full Text:

PDF

References


Jean LJ. Anaesthesia for Laparoscopic surgery. In: Miller RD, ed. Anesthesia. 7th ed. New York: Churchill Livingstone; 2010;2185-2202.

Tripathi DC, Shah KS, Dubey SR, Doshi SM, Raval PV. Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication. J Anaesthesiol Clin Pharmacol. 2011;27(4):475-80.

Sung CS, Lin SH, Chan KH, Chang WK, Chow LH, Lee TY. Effect of oral clonidine premedication on perioperative haemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Sin. 2000;38:23-9.

Laisalmi M, Koivusalo AM, Valta P, Tikkanen I, Lindgren L. Clonidine provides opioid sparing effect, stable haemodynamics and renal integrity during laparoscopic cholecystectomy. Surg Endosc. 2001;15:1331-5.

Goyagi T, Nishikawa T. Oral Clonidine premedication causes the quality of postoperative analgesics by intrathecal morphine. Anesth Analg. 1996;82:1192-6.

Aho M, Scheinin M, Lehtinen AM. Intramuscularly administered dexmedetomidine attenuates haemodynamic and stress responses to gynaecologic laparoscopy. Anesth Analg. 1992;75:932-9.

Joris J, Chiche JD, Lamy M. Clonidine reduces the haemodynamic changes induced by pneumoperitoneum during laparoscopic cholecystectomy. Br J Anaesth. 1995;74:A-124.

Malek J, Knor J, Kurzova A, Lopourova M. Adverse hemodynamic changes during laparoscopic cholecystectomy and their possible suppression with clonidine premedication: Comparison with intravenous and intramuscular premedication. Rozhl Chir. 1999;78:286-91.

Yu HP, Hseu SS, Yien HW. Oral clonidine premedication preserves heart rate variability for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2003;47:185-90.

Das M, Ray M, Mukherjee G. Haemodynamic changes during laparoscopic cholecystectomy: Effect of clonidine premedication. Indian J Anaesth. 2007;51:205

Hazra R, Manjunatha SM, Manuar MDB, Basu R, Chakraborty S. Comparison of the effects of intravenously administered dexmedetomidine with clonidine on hemodynamic responses during laparoscopic cholecystectomy. Anaesth Pain Intens Care. 2014;18(1):25-30

Raval DL, Mehta MK. Oral clonidine pre medication for attenuation of haemodynamic response to laryngoscopy and intubation. Indian J Anaesth. 2002;46:124-9.

Zalunardo MP, Zollinger A, Spahn DR, Seifert B, Radjaipour M, Gautschi K, et al. Effects of intravenous and oral clonidine on hemodynamic and plasma-catecholamine response due to endotracheal intubation. J Clin Anesth. 1997;9:143-7.