Comparison of hemodynamic responses of intravenous dexmedetomidine and esmolol infusion during laparoscopic cholecystectomy
Keywords:Dexmedetomidine, Esmolol, Hemodynamic responses, Laparoscopic cholecystectomy
Background: Laparoscopic cholecystectomy is one of the commonest surgery performed under general anesthesia in this set up but maintaining the hemodynamic stability is challenging in these patients. The present study was conducted to comparatively analyse the hemodynamic variations using intravenous dexmedetomidine and intravenous esmolol during laparoscopic cholecystectomy.
Methods: Study was conducted on 90 adult patients aged 18-60 years, of ASA grade I or II of both gender, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized into three groups of 30 patients each. Patients of Group A received esmolol infusion (loading: 1mg/kg and maintenance: 5-15µg/kg/min), patients of Group B received dexmedetomedine infusion (loading: 0.7µg/kg and maintenance: 0.4µg/kg/hr) and Group C (control group) received normal saline infusion. Patients were monitored for changes in heart rate, ECG, systemic blood pressure and EtCO2, at baseline, at 5 min and 10 min after giving study drug bolus, after induction, intubation, skin incision and CO2 insufflation. Thereafter, these changes were recorded at 15 min intervals till the end of surgery.
Results: It was observed that perioperative use of dexmedetomidine and esmolol infusions maintained better hemodynamic stability as compared to the normal saline in control group. Though the patients in esmolol group showed less fluctuations in BP and HR (as compared to control group), but, stability was better in the patients of dexmedetomidine group at all-time intervals.
Conclusions: Dexmedetomidine infusion was a better option for maintaining hemodynamic stability in comparison to emolol infusion during laparoscopic surgeries.
Tripathi DC, Shah KS, Dubey SR, Doshi SM, Raval PV. The effect of two different doses of intravenous clonidine premedication on hemodynamic stress response during laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2011;27:475-80.
Cunningham AJ, Brull SJ. Laparoscopic cholecystectomy: Anesthetic implications. Anaesth Analg. 1993;76:1120-33.
Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: A review of clinical applications. Curr Opin Anaesthesiol. 2008;21:457-61.
Chia YY, Chan MH, Ko NH, Liu K. Role of beta-blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth. 2004;93(6):799-805.
White PF, Wang B, Tang J, Wender RH, Naruse R, Sloninsky A. The effect of intraoperative use of esmolol and nicardipine on recovery after ambulatory surgery. Anesth Analg. 2003;97(6):1633-38.
Srivastava VK, Nagle V, Agrawal S, Kumar D, Verma A, Kedia S. Comparative Evaluation of Dexmedetomidine and Esmolol on Hemodynamic Responses During Laparoscopic Cholecystectomy. Journal of Clinical and Diagnostic Research. 2015 Mar;9(3):1-5.
Bhattacharjee DP, Saha S, Paul S, Roychowdhary S, Mondal S, Paul S. A comparative study of esmolol and dexmedetomidine on hemodynamic responses to carbon dioxide pneumoperitoneum during laparoscopic surgery. Anesth Essays Res. 2016;10:580-4.
Paul S, Bhattacharjee DP, Ghosh S, Dawn S, Chatterjee N. Efficacy of intraarticular dexmedetomidine for postoperative analgesia in arthroscopic knee surgery. Ceylon Medical Journal. 2010;55:111-5.
Godhki PS, Thombre SK, Sardesi SP, Hamagle KD. Dexmedetomidine as an anaesthetic adjuvant in laparascopic surgery: An observational study using entropy monitoring. J Anaesthesiol Clin Pharmacol. 2012;28(3):334-8.
Coloma M, Chiu JW, White PF, Armbruster SC. The use of esmolol as an alternative to remifentanil during desflurane anaesthesia for fast track outpatient gynaecologic laparoscopic surgery. Anesth Analg. 2001;92:352-7.