Effect of Intravenous Clonidine as Premedication on Haemodynamic Responses during Laparoscopic Cholecystectomy

Abstract

Background: Surgical laparoscopy is associated with significant pathophysiological changes due to pneumoperitoneum using carbon dioxide and haemodynamic alterations that need to be effectively attenuated. Clonidine an alfa-2 agonist is one of the agent recommended for the control of stress responses with laparoscopic surgery under general anaesthesia. Material & Method: In a randomized double blind study on 60 ASA grade I/II adult patients scheduled for laparoscopic cholecystectomy were included. Ethical clearance and Informed consent obtained. Group B (n=30) patients received plain infusion of ringer lactate and in group C (n=30) 1.5 mcg/kg of clonidine was added to the infusion of ringer lactate and given 30 minutes prior to the Induction of general anesthesia. The baseline and perioperative vital parameters noted. Pre medicated with injection glycopyrrolate 0.2 mg ranitidine 50mg, ondesetrone 4 mg and fentanyl citrate 1.5 µg/kg intravenously and induced with propofol 2 mg/kg. Endotracheal intubation was facilitated by succinylcholine 1.5 mg/kg, anaesthesia maintained by 50% oxygen in nitrous oxide, 0.6-1% isoflurane and muscle relaxant Vecuronium bromide 0.1 mg/kg with IPPV to maintain the EtCO2 between 30-40 mm Hg. Results: Intra operatively there was significant heart rate variation in group B (77.3 ± 10.4/min to 111.2 ± 13.7/min) than in group C (77.7± 9.4/min to 83.5 ± 8.4/min) and the mean blood pressure varied from 91.3 ± 10.05 mm of Hg to 109.6 ± 10.4 mmHg in group B and in group C 91.4 ± 11.6 mmHg to 93.9± 7.5 mmHg. In group B seven (23.33%) patients required intra-operative NTG drip for control of hypertension but not in group C. One patient in group C required inj. Atropine 0.6 mg for control of bradycardia. Patients in group C were more sedated whereas VAS score, requirement of analgesic and incidence of shivering were significantly less in group C patients than in group B. Conclusion: Premedication with intravenous 1.5 mcg/kg clonidine in ASA I/ II patients is safe and effective for hemodynamic stability during laparoscopic cholecystectomy