Effects of Dexmedetomidine on Intraoperative Hemodynamic Responses in Patients Undergoing Laparoscopic Cholecystectomy: A Randomised Double Blind Trial
Background: Dexmedetomidine is a highly selective alpha 2 agonist with dose dependent sedative sympatholytic analgesic properties and is used as an anaesthetic adjuvant. We have evaluated the effect of dexmedetomidine on hemodynamic responses to critical incidences such as laryngoscopy, endotracheal intubation, creation of pneumoperitoneum and extubation in patients undergoing laparoscopic cholecytectomy.
We have used a loading dose of 0.5mcg/kg over 10 minutes followed by infusion of 0.3mcg/kg/hour for the control of hemodynamic response to laparoscopy.
Methods: Patient of either sex aged between 18-50 yrs, belonging to ASA (American society of anaesthesiology) I and II posted for laparoscopic cholecystectomy were included. Institutional ethical committee clearance was obtained prior to study. After enrolment written valid consent was taken. 60 patients were enrolled and a written valid informed consent was taken. The patients were divided into two groups 30 each with computerized randomization. Base line parameters were noted. Observer and patient was blinded for the content of syringe. Group A received injection dexmedetomidine and group B received bolus and infusion of normal saline at same rate. Routine general anaesthesia was instituted. Parameters were noted after induction, after intubation, after co2 insufflation, after 20 min, after 40 min, after co2 deflation, after extubation, after 1 and 2 hrs post-extubation.
Results: Group A showed significantly less rise in HR and MAP than Group B. Requirement of intraoperative propofol was more in Group B. There was no significant difference for time taken to awakening in both groups.
Conclusion: We found Injection Dexmedetomidine in given doses gave good hemodynamic control with minimal undesired effects during laparoscopy.
 Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic and analgesic properties of small dose dexmedetomidine infusion. Anesth Analg 2000; 90(3):699-705.
 Wilcox S, Vandam LD. Alas, poor Trendelenburg and his position! A critique of its uses and effectiveness. Anesth Analg. 1988; 67(6):574-8.
 Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 1992; 77(6):1134-42.
 Isik B, Arslan M, Ozsoylar O, Akçabay M. The effects of α2-adrenergic receptor agonist dexmedetomidine on hemodynamic response in direct laryngoscopy. Open Otorhinolaryngol J 2007; 1:5-11.
 Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lcour T, Griffin J, et al. Dexmedetomidine infusion during laparoscopic surgery. The effect on recovery outcome variables. Anesth Analg. 2008, 106(6):1741-8.
 Manne GR, Upadhyay MR, Swadia VN. Effects of low dose dexmedetomidine infusion on hemodynamic stress response, sedation and post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy. Indian J Anaesth. 2014; 58(6):726-31.
 Pyakurel K, Rajbanshi I, Thapa C, Regmi G, Dexmedetomidine as a single bolus dose in laparoscopic cholecystectomy under general anaesthesia- A comparison of different doses. BJHS 2020; 5(2)12:1045-1049.
 Bajwa SJ, Kaur J, Singh A, Parmar S, Singh G, Kulshrestha A, et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with preoperative dexmedetomidine. Indian J Anaesth 2012; 56(2):123-8.
 Feld JM, Hoffman WE, Stechert MM, Hoffman IW, Ananda RC. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery. J Clin Anesth. 2006; 18(1):24-8.
 Ramsay MA, Saha D, Hebeler RF. Tracheal resection in the morbidity obese patient. The role of dexmedetomidine. J Clin Aneth. 2006; 18(60:452-4.
 Haselman MA. Dexmedetomidine: A useful adjunct to consider in some high-risk situations. AANA J 2008; 76(5):335-9.
 Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative hemodynamic stability. Anesthesia. 1997; 52(8):736-44.
 Keniya VM, Ladi S, Nalphade R. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011; 55(4):352-7.
 Bhattacharjee DP, Nyek SK, Dawn S, Bandopadhyay G, Gupta K. Effects of dexmdetomidine on haemodynamics in patients undergoing laparoscopic cholecystectomy- A comparative study. J Anaesth Clin Pharmacol. 2010; 2:45-8.
|Issue||Vol 7 No 4 (2021): Autumn|
|Dexmedetomidine Hemodynamic responses Laparoscopic cholecystectomy|
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