Abstract
Background and aims: Clonidine has been used via different routes to suppress the haemodynamic stress responses associated with capnoperitoneum. This study was designed to compare the stress response attenuating effect of equal doses of intrathecal (IT) and intravenous (IV) clonidine during capnoperitoneum under general anaesthesia. Method: Seventy-five patients satisfying inclusion criteria were randomly allocated to three groups of 25 patients each. Group C-IV patients received 1µg/kg i.v. clonidine, 15mins before induction. Group C-IT patients received the same dose intrathecally just before induction. Group N was the control group. Intraoperative haemodynamic parameters, post-operative pain and sedation were assessed. Patients requiring nitroglycerine (NTG) to maintain mean arterial pressure (MAP) below 20% of baseline were noted. Results: There was a statistically significant difference (p=0.04) in the number of patients who required NTG between group C-IT and group C-IV [0% vs 16% (p=0.04)] and between group C-IT and group N [0% vs 36% (p=0.001)]. Rescue analgesia was required in 16 patients in group C-IV, 10 patients in group C-IT and 20 patients in group N in the first two hours after surgery. None of the patients in either group were deeply sedated at tracheal extubation. Conclusion: At 1µg/kg, IT clonidine is more effective than IV clonidine in suppressing haemodynamic stress response to capnoperitoneum. Both IT and IV clonidine provide early post-operative analgesia without causing much sedation.
Highlights
Capnoperitoneum during laparoscopy causes significant haemodynamic changes.[1,2,3,4]Pharmacological agents like β-blockers, opioids, nitroglycerine and dexmedetomidine have been used to minimize such derangements with varied results.[5,6,7,8,9] Nitroglycerine (NTG) is commonly used as a rescue measure for intraoperative hypertension.[10,11] Clonidine, an -2 adrenoreceptor agonist, reduces sympathetic outflow and is advantageous in laparoscopic procedures.[12]
Our primary objective was to assess the number of patients requiring NTG to maintain mean arterial pressure (MAP) within 20% of baseline
The groups were comparable in terms of age, sex distribution, American Society of Anaesthesiologists (ASA) physical status, duration of pneumoperitoneum, duration of surgery and type of surgery (Table 1)
Summary
Capnoperitoneum during laparoscopy causes significant haemodynamic changes.[1,2,3,4]Pharmacological agents like β-blockers, opioids, nitroglycerine and dexmedetomidine have been used to minimize such derangements with varied results.[5,6,7,8,9] Nitroglycerine (NTG) is commonly used as a rescue measure for intraoperative hypertension.[10,11] Clonidine, an -2 adrenoreceptor agonist, reduces sympathetic outflow and is advantageous in laparoscopic procedures.[12]. Clonidine can be administered via various routes [oral, intramuscular (IM), intravenous (IV), intrathecal (IT), epidural] and used in doses ranging from 1 – 8μg/kg.[14,15,16,17] At equal doses, IT clonidine has been shown to produce better analgesia than IV clonidine.[18] The effect of IT clonidine on maintaining haemodynamic stability during laparoscopic procedures has not been studied so far. This study was designed to compare the stress response attenuating effect of equal doses of IT and IV clonidine during capnoperitoneum. Our primary objective was to assess the number of patients requiring NTG to maintain mean arterial pressure (MAP) within 20% of baseline. This study was designed to compare the stress response attenuating effect of equal doses of intrathecal (IT) and intravenous (IV) clonidine during capnoperitoneum under general anaesthesia
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