Effect of Preoperative Intravenous Clonidine on Hemodynamic Response During Laparoscopic Surgeries

Abstract

BACKGROUND AND OBJECTIVES: Laparoscopy is a minimally invasive procedure used as a diagnostic and therapeutic tool for abdominal and pelvic pathologies. Laparoscopy offers many benefits compared to open surgeries, but it leads to increase in stress hormones, increased peripheral vascular resistance and decreased cardiac output causing hemodynamic fluctuation. In addition, ventilatory changes and increases in partial pressure of carbon dioxide also occur during laparoscopic surgeries due to pneumoperitoneum. To overcome these hemodynamic effects of insufflation various methods have been used like combined epidural with general anesthesia, propofol infusion, high dose of opioids, beta blockers, nicardipine, oral clonidine etc. In this study, we used intravenous clonidine as premedication to suppress these changes. METHODS: After obtaining ethical committee clearance and informed consent from patient, we enrolled 60 adult patients, aged between 20-60 years, of ASA grade 1 and 2 posted for laparoscopic intra-abdominal surgeries. The patients were divided into 2 groups of 30 each randomly, viz: Group C Study group: Injection clonidine, 2mcg/kg, as premedication was given intravenously, 15 min prior to induction of anesthesia. Group N Control group: received injection normal saline, 5cc, intravenously. For both the groups same type of anesthesia and analgesia was given. Heart rate, blood pressure, mean arterial pressure were recorded in both groups. Sedation, incidence of post-operative nausea vomiting after extubation were also observed. Statistical analysis was done using student T test and P value obtained. RESULTS: In the present study, decreases in heart rate, systolic, diastolic and mean arterial blood pressures were noticed in the clonidine group. Inspite of maintaining normocapnia and keeping intra-abdominal pressure below 14mmm of Hg significant rises in heart rate, systolic, diastolic and mean arterial blood pressures were noticed in the control group. CONCLUSION: From this study, we conclude that intravenous clonidine 2mcg/kg, given 15 min prior to induction provides stable hemodynamics and protection against stress response to intubation and carbon dioxide insufflation in patients undergoing laparoscopic surgeries. Clonidine provides the added advantages of reduction in postoperative complications of nausea, vomiting and shivering.