Clonidine Versus Nitroglycerin Infusion in Laparoscopic Cholecystectomy

Abstract

Background and Objectives:Laparoscopic surgery offers the advantages of minimally invasive surgery; however, pneumoperitoneum and the patient's position induce pathophysiological changes that may complicate anesthetic management. We studied the effect of clonidine and nitroglycerin on heart rate and blood pressure, if any, in association with these drugs or the procedure, as well as the effect of these drugs, if any, on end-tidal carbon dioxide pressure and intraocular pressure.Methods:Sixty patients (minimum age of 20 years and maximum age of 65 years, American Society of Anesthesiologists class I or II) undergoing laparoscopic cholecystectomy were randomized into 3 groups and given an infusion of clonidine (group I), nitroglycerin (group II), or normal saline solution (group III) after induction and before creation of pneumoperitoneum. We observed and recorded the following parameters: heart rate, mean arterial blood pressure, end-tidal carbon dioxide pressure, and intraocular pressure. The mean and standard deviation of the parameters studied during the observation period were calculated for the 3 treatment groups and compared by use of analysis of variance tests. Intragroup comparison was performed with the paired t test. The critical value of P, indicating the probability of a significant difference, was taken as < .05 for comparisons.Results:Statistically significant differences in heart rate were observed among the various groups, whereas comparisons of mean arterial pressure, intraocular pressure, and end-tidal carbon dioxide pressure showed statistically significant differences only between groups I and III and between groups II and III.Conclusion:We found clonidine to be more effective than nitroglycerin at preventing changes in hemodynamic parameters and intraocular pressure induced by carbon dioxide insufflation during laparoscopic cholecystectomy. It was also found not to cause hypotension severe enough to stop the infusion and warrant treatment.

Comparison between intravenous and intrathecal clonidine for postoperative analgesia of patients submitted to laparoscopic cholecystectomy: randomized clinical trial

“…Cholelithiasis affects approximately 10% of the general population and acute cholecystitis is its most frequent complication occurring in 15% to 26% of cases. 1 The laparoscopic approach provides minimally invasive surgery benefits but promotes pathophysiological changes which can challenge anesthesia and postoperative pain management treatment, 1 , 2 , 3 with a risk of postoperative pain similar to open surgery. 4 , 5 …”

Effects of clonidine premedication on perioperative hemodynamic response, anesthetic requirements and postoperative analgesia for patients undergoing laparoscopic gynecological surgeries: A randomized study

“…[1][2][3] These changes propose new anesthetic challenges to maintain the hemodynamic stability. To tackle this, various anesthetic techniques and pharmacological agents such as opioids, 4 esmolol, 5 Sodium Nitroprusside, Nitroglycerin, 6 lignocaine, 7 Pregabalin, 8,9 and Magnesium sulfate 10 are being used but the success rate is limited. "Clonidine is a combined α 1 and α 2 adrenoceptor agonist with a predominant α 2 action (α 1 : α 2 =1:220).…”

To study the efficacy and post-operative sedation in intravenous and intrathecal clonidine in patients undergoing laproscopic assisted vaginal hysterectomy under general anesthesia

“…However caproperitoneum and position of patient during Various pharmacological methods have been tried to overcome complications associated with pneumoperitoneum. Drugs like adrenoreceptor blockers, beta blockers, 2 calcium channel blockers, opioids, magnesium sulfate, 3 and vasodilators 4 have been tried to improve quality of recover in laparoscopic procedures.…”

“…6 Clonidine through i.v route has been used as a single dose prior to induction or as continuous infusion throughout laparoscopic procedures. 4 Single dose clonidine has also been effective in attenuating haemodynamic response to capnoperitoneum. As the half-life of clonidine is 9-12 hours intravenous clonidine, single dose has been used in various doses ranging from 1mcg/kg 7,8 bodyweight to 8 mcg/kg 1 bodyweight.…”