Clinical efficacy of dexmedetomidine in two different doses to attenuate the hemodynamic changes during laparoscopic cholecystectomy

Authors

  • Tahir Ahamad Masoori Department of Anaesthesiology and Critical Care, Subharti Medical College, Meerut, Uttar Pradesh, India
  • Kumkum Gupta Department of Anaesthesiology and Critical Care, Subharti Medical College, Meerut, Uttar Pradesh, India
  • Salony Agarwal Department of Anaesthesiology and Critical Care, Subharti Medical College, Meerut, Uttar Pradesh, India
  • Manoranjan Bansal Department of Anaesthesiology and Critical Care, Subharti Medical College, Meerut, Uttar Pradesh, India
  • Azka Zuberi Department of Anaesthesiology and Critical Care, Subharti Medical College, Meerut, Uttar Pradesh, India
  • Abdul Samad Department of Anaesthesiology and Critical Care, Subharti Medical College, Meerut, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20180623

Keywords:

Dexmedetomidine, Hemodynamic changes, Laryngoscopy, Laparoscopic cholecystectomy, Pneumoperitoneum

Abstract

Background: Laryngoscopy and laparoscopy lead to predictable hemodynamic changes. Dexmedetomidine is selective 2 agonist with dose dependent sedation, sympatholysis and analgesia, hence could provide stable hemodynamics during laparoscopic surgeries. The present study was aimed to compare the clinical efficacy of dexmedetomidine infusion in two different doses to attenuate the hemodynamic variations during laparoscopic cholecystectomy.

Methods: Total 60 adult patients of ASA physical status I and II of both gender, scheduled for elective laparoscopic cholecystectomy, were randomly allocated into two groups of 30 patients. All patients were infused with loading dose of dexmedetomidine (1µg/kg) before induction. Patients of Group 1 received maintenance infusion of dexmedetomidine in doses of 0.3µg/kg/h and patients of Group 2 received maintenance infusion of dexmedetomidine in doses of 0.6µg/kg/h, continued till the end of surgery. Heart rate and blood pressure were recorded preoperatively, after dexmedetomidine administration, after induction, intubation, after creation of pneumoperitoneum and postoperatively. Intraoperative changes in heart rate and blood pressure were noted as primary variables and dexmedetomidine related side effects were noted as secondary outcomes, for statistical analysis.

Results: The hemodynamic responses were attenuated in patients of both groups after laryngoscopy, intubation and creation of pneumoperitoneum but patients of Group 2 (0.6µg/kg/h) showed more stability in hemodynamics. The difference between the group was statistically significant (p value=0.001). No any evident complication or side effects occurred.

Conclusions: Dexmedetomidine infusion was effective for attenuating the hemodynamic changes due to laryngoscopy and laparoscopy but were better with maintenance infusion of dexmedetomidine in dose of 0.6µg/kg/h. 

References

Westerband A, Van Dc Water, Amzallag M, Lebowitz P. Cardiovascular changes during Laparoscopic Cholecystectomy. Surg Gynecol Obs. 1992;175:535-8.

Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML. Hemodynamic changes during laparoscopic cholecystectomy. Anesthesia analgesia. 1993;76(5):1067-71.

Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation: Influence of duration of laryngoscopy with or without prior lignocaine. Anaesthesiology. 1977; 7:381.

Helfman SM, Gold MI, Delisser EA, Herrington CA. Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl, or esmolol? Anesth Analg. 1991;73:502-04.

Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: A review of clinical applications. Curr Opin Anaesthesiol. 2008;21:457-61.

Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympatho-adrenal responses to tracheal intubation and reduces the need for thiopentone and perioperative Fentanyl. Br J Anaes. 1991;68:126-31.

Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992;77:1134-42.

Sudheesh K, Harsoor SS. Dexmedetomidine in anaesthetic practice: A wonder drug? Indian J Anaes. 2011;55:323-4.

Hashimoto S, Hashikura Y, Munnakata Y, Kawasaki S, Makuchi P. Changes in cardiovascular and respiratory system during laparoscopic cholecystectomy. J Laparoendosc Surg. 1993;3:535-9.

Bekker A, Sturaitis M, Bloom M, Moric M, Golfinos J, Parker E, et al. Effect of Dexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy. Anaesthesia and Analgesia. 2008;107:1340-7.

Turan G, Ozgultekin A, Turan C, Dincer E, Yuksel G. Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery. European J anaesthesiology. 2008;25(10):816-20.

Patel CR, Engineer SR, Shah BJ, Madhu S. Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: A study with entropy analysis. Indian J Anaesth. 2012;56:542-6.

Laha A, Ghosh S, Sarkar S; Attenuation of sympatho-adrenal responses and anesthetic requirement by dexmedetomidine. Anesth Essays Res. 2013;7:65-70.

Gupta K, Bansal M, Gupta PK, Singh M, Agarwal S, Tiwari V. Dexmedetomidine premedication with three different dosages to attenuate the adverse haemodynamic responses of direct laryngoscopy and intubation: a comparative evaluation. Ain-Shams J Anaesthesiol. 2016;9:66-71.

Kunisawa T, Nagata O, Nagashima M. Dexmedetomidine suppresses the decrease in blood pressure during anaesthetic induction and blunts the cardiovascular responses to tracheal intubation. Journal of Clin Anaesth. 2009;21:194-9.

Sagirolu AE, Celik M, Orhon Z, Yuzer S, Sen B. Different doses of dexmeditomidine on controlling hemodynamic responses to tracheal intubation. The Internet J Anaesth. 2010;26:45-8.

Basar H, Akpinar S, Doganci N, Buyukkocak U, Kaymak C, Sert O, et al. The effect of preanaesthetic single dose dexmedetomidine on induction, haemodynamic and cardiovascular parameters. Journal of Clin Anaesth. 2008;20:431-6.

Bhattacharjee DP, Nayek SK, Dawn S, Bandopadhyay G, Gupta K. Effect of dexmedetomidine on hemodynamics in patients undergoing laparoscopic cholecystectomy-A Comparative study. J Anaesth Clin Pharmacol. 2010;26:45-48.

Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A, Otelcioglu S. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation. Drugs in R & D. 2006;7(1):43-52.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Ind J anaesthesia. 2011;55(4):352-7.

Sulaiman S, Karthekeyan RB, Vakamudi M, Sundar AS, Ravullapalli H, Gandham R. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting. Annals of cardiac anaesthesia. 2012;15(1):39.

Bakhamees HS, El-Halafawy YM, El-Kerdawy HM, Gouda NM, Altemyatt S. The effect of Dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass. Middle East J Anaesthesiology. 2007;19:537-51.

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Published

2018-02-22

How to Cite

Ahamad Masoori, T., Gupta, K., Agarwal, S., Bansal, M., Zuberi, A., & Samad, A. (2018). Clinical efficacy of dexmedetomidine in two different doses to attenuate the hemodynamic changes during laparoscopic cholecystectomy. International Journal of Research in Medical Sciences, 6(3), 959–965. https://doi.org/10.18203/2320-6012.ijrms20180623

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Original Research Articles