Effect of intravenous clonidine premedication in patients undergoing laparoscopic cholecystectomy

S. K. Gvalani, Hemant S. Pawar


Background: Pneumoperitoneum to facilitate laparoscopic surgery produces hemodynamic changes that can be harmful for the elderly as well as patients with cardiovascular compromise. Clonidine is an alpha- 2 agonist that can attenuate these changes.

Methods: This study of 100 patients was a single blind prospective randomized controlled study. Patients were randomly divided into two groups of 50 each. The clonidine group received 2 microgm/kg iv clonidine in 10 ml normal saline 15 minutes prior to induction. The placebo group received only normal saline. Hemodynamic parameters and incidence of vomiting and shivering were noted.

Results: Data was analysed by Pearson’s chi-square test. Clonidine significantly attenuated the rise in heart rate, and the blood pressure. The incidence of postoperative nausea and vomiting was less in the clonidine group. It also reduced shivering.

Conclusions: 2 microgm/kg of clonidine iv can be reasonably recommended as a premedicant for laparoscopic procedures in otherwise healthy patients. However further study is required to test its efficacy in patients with compromised cardiovascular function.


Alpha 2 agonists, Hemodynamic attenuation, Laparoscopic surgery

Full Text:



Joris J. Anesthetic management of laparoscopy. In: Miller RD, Anesthesia, Churchill Livingstone, New York;1994:2011-2029.

Wahba RWM, Beique F, Kleiman SJ. Cardiopulmonary function and laparoscopic cholecystectomy. Can J Anaesth. 1995;45:51-63.

Sharma DC, Brandstetter RD, J.M. Brensilver, Jung LD. Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest. 1996;110:810-5.

Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg. 1993;76:1067-71.

Mealy K, Gallagher H, Lennon F, Traynor O, Hyland J. Physiological and metabolic responses to open and laparoscopic cholecystectomy. Br J Surg. 1992;79:1061-4.

Hirvonen EA, Nuutinen LS, Vuolteenaho O. Hormonal responses and cardiac filling pressures in head-up or head-down position and pneumoperitoneum in patients undergoing operative laparoscopy. Br J Anaesth. 1997;78:128-33.

Torrielli R, Cesarini M, Winnock S, Cabiro C, Mene JM. Modifications hemodynamiques durant la coelioscopie: etude menee par bioimpedance electrique thoracique. Can J Anaesth. 1990;37:46—

Oleary E, Hubbard K, Tormey W, Cunningham AJ. Laparoscopic cholecystectomy: hemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth. 1996;76:640-4.

Roith DL, Barn H, Nyska M, Glick SM. The effect of abdominal pressure on plasma antidiuretic hormone levels in the dog. J Surg Res. 1982;32:65-9.

Punnonen R, Viinamaki O. Vasopressin release during laparoscopy: role of increased intra-abdominal pressure. Lancet. 1982;1:175-6.

Herruzo JAS, Moreno D, Gonzalez et al. Effect of intrathoracic pressure on plasma arginine vasopressin levels. Gastroenterology. 1991;101:607-17.

Aho Z, Lehtinen AM, Laatikainen T, Korttila K. Effects of intramuscular clonidine on hemodynamic and plasma 13-endorphin responses to gynecologic laparoscopy. Anesthesiology. 1990;72:797-802.

Aho M, Scheinin M, Lehtinen AM, Erkola O, Vuorinen J, Korttila K. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg. 1992;75:932-9.

Kulka PJ, Tryba M, Zenz M. Dose response effects of intravenous clonidine on stress response during induction of anaesthesia in coronary artery bypass graft patients. Anesth Analg. 1995;80(2):263-8.

Ishizaki Y, Bandae Y, Shimomura K. Safe intraabdominal pressure of carbon dioxide pneumoperitoneum during laparoscopic surgery. Surgery. 1993;111(3):549-54.

Cunningham AJ, Turner J, Rosenbaum S. Transoesophageal echocardiographic assessment of hemodynamic function during laparoscopic cholecystectomy. Br J Anaesth. 1993;70:621.

Ray M, Bhattacharjee DP. Effect of clonidine and magnesium sulphate on anaesthetic consumption, hemodynamics and postoperative recovery a comparative study. Indian J Asso. 2010;54(2):137-41.

Yotsui T. Clonidine premedication prevents sympathetic hyperactivity but does not prevent hypothalamo-pituitary-adrenocortical responses in patients undergoing laparoscopic cholecystectomy. J Anesth. 2001;15:78-82.

Buggy D, Higgins P, Donovan OF. Clonidine at induction reduces shivering after general anaesthesia. Can J Anaesth. 1997;44:263-7.

Nicolaou G, Jonston CE, Bristow GK. Clonidine decreases vasoconstriction and shivering threshold without affecting the sweating threshold. Can J Anaesth. 1997;44:636-44.