Research Article

Comparison of Magnesium Sulphate and Dexmedetomidine for Attenuation of Stress Response in Patients undergoing Laparoscopic Cholecystectomy under General Anaesthesia by Measuring Biochemical Markers of Stress Response: A Prospective Randomized Study

Abstract

Background: Laryngoscopy, endotracheal intubation, pneumoperitoneum creation and extubation is stressful event marked by hemodynamic changes during laparoscopic procedures. This increases secretion of many biochemical stress markers for example, cortisol levels, TNF-alpha levels, CRP levels, blood Sugar levels. Aim of the study was to compare magnesium sulphate and dexmedetomidine for attenuation of stress response in patients undergoing laparoscopic cholecystectomy under general anaesthesia by measuring biochemical markers of stress response.
Methods: 60 patients, age between 18 to 60 years of either sex, who were undergoing Laparoscopic cholecystectomy randomized into two groups of 30 patients each by computer generated random number. Group M- received magnesium sulphate 50 mg/kg and group D -  received dexmedetomidine 1 µg/kg.
Results: The demographic data were comparable in both groups. Cortisol levels rise in both the groups but significantly more in group M than group D at 30 minute (p-value < 0.001) and 4 hours (p-value < 0.001). CRP levels rise in both the groups but significantly more in group M than group D at 30 min (p-value 0.013) and 4 hours (p-value 0.020). Blood sugar levels rise in both the groups but significantly more in group M than group D at 30 min, 4 hours and 24 hours (p-value <0.001). TNF-alpha levels rise in both the groups but significantly more in group M than group D at 30 min (p-value 0.005) and 4 hours (p-value 0.007).
Conclusion: We conclude that biochemical stress marker levels (Cortisol levels, TNF-alpha, levels, CRP levels, Blood Sugar levels) were more increased in the magnesium sulphate group compared with the dexmedetomidine group. Heart rate and Mean arterial pressure   were higher in the Magnesium sulphate group than the Dexmedetomidine group. Dexmedetomidine is better than magnesium sulphate in attenuating the stress of surgery in patients undergoing laparoscopic cholecystectomy.

[1] Chandrasekaran V, Jayaraj P. Comparison of Dexmedetomidine and Magnesium Sulphate to assess neuroendocrine response using blood glucose as a marker in laparoscopic Cholecystectomy. IOSR-JDMS. 2017; 16(10):77-80.
[2] Zarif P, Abdelaal Ahmed Mahmoud A, Abdelhaq M, Mikhail H, Farag A. Dexmedetomidine versus Magnesium Sulfate as Adjunct during Anesthesia for Laparoscopic Colectomy. Anesthesiol Res Pract. 2016; 2016:1-7.
[3] Randell T. Haemodynamic responses to intubation: What more do we have to know? Acta Anesthesiol Scand. 2004; 48: 393-5.
[4] Bucx MJ, van Geel RT, Scheck PA, Stijnen T. Cardiovascular effects of forces applied during laryngoscopy. Anaesthesia. 1992; 47:1029–33.
[5] Elbert JP, Pearson JD, Gelmon S, Harris G, Bradley EL. Circulatory responses to laryngoscopy: the comparative effects of placebo, fentanyl and esmolol. Can J Anaesth. 1989; 36: 301-6.
[6] Daabias M, Hashish M, Alotoibi R, Aldafterdar R. Effects of lornoxicon on the haemodynamic and catecholamine response to laryngoscopy and tracheal intubation. Eur J Clin Pharmacol. 2011; 67(8):783-6.
[7] Das M, Pradhan BK, Samantray RC. Comparative study on haemodynamic responses during intubation using etomidate, propofol and thiopentone in laparoscopic cholecystectomy surgeries. Innovative Journal of Medical and Health Science. 2015; 5: 150-158.
[8] Gutierrez T, Hornigold R, Pearce A. The systemic response to surgery. Surgery. 2014; 32(3):149-52.
[9] Lenz RJ, Thomas TA, Wilkins DG. Cardiovascular changes during laparoscopy: Studies of stroke volume and cardiac output using impedance cardiography. Anaesthesia. 1976; 31: 4-7.
[10] Myre K, Rostrup M, Buanes T, Stokland O. Plasma catecholamines and haemodynamic changes during pneumoperitoneum. Acta Anaesthesiol Scand. 1998; 42: 343-7.
[11] Walder AD, Aitkenhed AR. Role of vasopressin in the haemodynamic response to laparoscopic cholecystectomy. Br J Anaesth. 1997; 78: 264-6.
[12] Desborough J. The stress response to trauma and surgery. Br J Anaesth. 2000; 85(1):109-17.
[13] Gupta K, Maggo A, Jain M, Gupta P, Rastogi B, Singhal A. Blood glucose estimation as an indirect assessment of modulation of neuroendocrine stress response by dexmedetomidine versus fentanyl premedication during laparoscopic cholecystectomy: A clinical study. Anesth Essays Res. 2013; 7(1):34-8.
[14] Sengupta J, Paul S, Biswas P, Bhattacharjee D. Effects of magnesium sulfate on hemodynamic response to carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Anesth Essays Res. 2013; 7(2):228.
[15] Hwang JY, Na HS, Jeon YT, Ro YJ, Kim CS, Do SH. I.V. infusion of magnesium sulphate during spinal anaesthesia improves postoperative analgesia. Br J Anaesth. 2010; 104(1):89-93.
[16] Deshpande J, Panse N, Madke E. Comparative evaluation of Dexmedetomidine and Magnesium Sulphate in attenuating airway pressor response during extubation in patients undergoing mastoidectomies. Arch Anesth & Crit Care. 2022; 8(3):201-207.
[17] Kamble SP, Bevinaguddaiah Y, Nagaraia DC, Pujar VS, Anandaswamy TC. Effect of Magnesium sulphate and Clonidine in attenuating haemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy. Anesth Essays Res. 2017; 11:67-71.
[18] Dongare D, Gharde S. Effects of Dexmedetomidine on Intraoperative Hemodynamic Responses in Patients Undergoing Laparoscopic Cholecystectomy: A Randomised Double Blind Trial. Arch Anesth & Crit Care. 2021; 7(4):227-233.
[19] Sharma ANG, Shankaranarayana PP. Pre-medication with I.V. dexmedetomidine Vs I.V. clonidine in attenuating the pressor response during laryngoscopy & endotracheal intubatiom. International Journal of Biomedical Research. 2014; 5(7): 465-467.
[20] Yacout A, Osman H, Abdel-Daem M, Hammouda S, Elsawy M. Effect of intravenous dexmedetomidine infusion on some proinflammatory cytokines, stress hormones and recovery profile in major abdominal surgery. Alexandria J Med. 2012; 48(1):3-8.
[21] Sari R, Sevinc A. The effects of laparascopic cholecystectomy operation on C-reactive protein, hormones, and cytokines. J Endocrinol Invest. 2004; 27(2):106-10.
[22] Harsoor S, Rani D, Lathashree S, Nethra S, Sudheesh K. Effect of intraoperative Dexmedetomidine infusion on Sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia. J Anaesthesiol Clin Pharmacol. 2014; 30(1):25-30.
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IssueVol 10 No 2 (2024): Spring QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v10i2.15064
Keywords
Biochemical Stress Marker Cortisol Dexmedetomidine Magnesium Sulphate
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How to Cite
1.
Jaisawal S, Yadav A, Kumar S, Yadav R, Nagpal V. Comparison of Magnesium Sulphate and Dexmedetomidine for Attenuation of Stress Response in Patients undergoing Laparoscopic Cholecystectomy under General Anaesthesia by Measuring Biochemical Markers of Stress Response: A Prospective Randomized Study. Arch Anesth & Crit Care. 2023;10(2):154-159.