Title: Efficacy of Intravenous Clonidine as Compared to Oral Clonidine on Hemodynamic Changes during Laparoscopic Cholecystectomy - A Randomized Controlled Trial
Authors: Anuraj V T, Sethunadh R
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.70
Abstract
Background: Laparoscopic technique has almost replaced the open method of cholecystectomy. The anesthesia for laparoscopic cholecystectomy is very challenging because of the effects of pneumoperitoneum on various organ systems mainly the cardiovascular system. In this study we have compared the efficacy of intravenous clonidine as compared to oral clonidine in reducing the hemodynamic effects of pneumoperitoneum.
Materials and Methods: This prospective randomized controlled study was performed in 70 patients posted for elective laparoscopic cholecystectomy in a tertiary care centre. Patients were randomized into two groups, Group 1 patients receiving 3 µg/kg of oral clonidine and Group 2 patients receiving 3 µg/kg of intravenous clonidine. Blood pressure, Heart rate were monitored at appropriate intervals
Results: Patients in both groups had reduced hemodynamic responses to pneumoperitoneum. The incidence of hypotension and bradycardia were more common in the in the iv Clonidine group.
Conclusion: Premedication with oral clonidine is equally efficacious as intravenous clonidine in reducing the hemodynamic stress response to pneumoperitoneum.
Keywords: Laparoscopic cholecystectomy, pneumoperitoneum, clonidine.
References
- Anthony J. Cunningham Cathal Nolan; Anaesthesia for invasive procedures; Clinical Anesthesia, 5th Edition by Barash, PaulG.; Cullen, Bruce F; Stoelting, Robert K; Chapter 38, 2205 — 2211
- Safran DB, Orlando R 3rd, Physiologic effects of pneumoperitoneum; Am j surg 167;281, 1994 A.
- Jean L. Joris MD , JeanDaniel Chiche MD, Jean Luc M. Canivet MD, Nicolas J. Jacquet MD , Jean Jacques Y. Legros MD and Maurice L. Lamy MD "Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine" Journal of the American College of Cardiology Volume 32, Issue 5, 1 November 1998, Pages 1389 - 1396.
- Jean L. Joris, MD, Didier P. Noirot, MD, Marc J. Legrand, MD,Nicolas J. Jacquet, MD, and Maurice L. Lamy, MD Hemodynamic Changes During Laparoscopic Cholecystectomy Anesth Analg 1993; 76: 1067-1071.
- Reid CW, Martineau RJ and Hull KA, " hemodynamic consequences of abdominal insufflation with C02 laparoscopic cholecystectomy", Canadian Journal of Anaesthesia 39:A132, 1992.
- Kulka "Difficult airway management in a patient with severe aortic stenosis, coronary artery disease, and heart failure", Journal of Clinical Anesthesia, Volume 14, Issue 2, Pages 150-153
- Dingle HR, "Antihypertensive drugs - anaesthesia", 1966,21:151
- Shirbman AJ, Smith G„ 'Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation", British Journal of Anaesthesia, 1987 March, 59(3):295 — 299.
- Nicolaou G, Jonston CE, Bristow GK, "Clonidine decreases vasoconstriction and shivering threshold, without affecting the sweating threshold". Can J Anaesthe 1997; 44(suppl): 636-44.