Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication

Tripathi, Deepshikha; Shah, Komal S; Dubey, Santosh R; Doshi, Shilpa M; Raval, Punit Vinodkumar

doi:10.4103/0970-9185.86586

Cited by 42 publications

(38 citation statements)

References 13 publications

(16 reference statements)

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“…Tripathi et al in has studied that Clonidine, 2 μg/ kg intravenously, 30 min before induction is safe and effective in preventing the hemodynamic stress response during laparoscopic cholecystectomy [9] . Sameena kousar et al compared effect of Fentanyl and Clonidine for attenuation of the haemodynamic response to laryngocopy and endotracheal intubation and found that Clonidine showed better attenuation of the sympathetic response [10] .…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study of Efficacy of Clonidine in Attenuating Haemodynamic Response to Laryngoscopy and Tracheal Intubation

Acharya¹,

Routray²

2017

AIMDR

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Background: Laryngoscopy and endotracheal intubation is often associated with hypertension and tachycardia because of sympatho-adrenal stimulation. In patients with cardiovascular and cerebrovascular disease, this sudden rise in heart rate and blood pressure can produce myocardial ischemia, pulmonary oedema and cerebral haemorrhage. Many drugs have been tried to blunt this hemodynamic response but none is ideal. Our aim was to study the efficacy of 3µg/kg clonidine intravenously, given 15 minutes before laryngoscopy and intubation in obtunding the hemodynamic response. Methods: One hundred patients were assigned randomly into two groups. Group I (n=50) received 10 ml of normal saline and group II (n=50) received injection Clonidine 3µg/kg diluted to 10 ml normal saline intravenously over 120 seconds, 15 minutes prior to laryngoscopy and intubation. After premedication anaesthesia was induced with thiopentone till loss of eye lash reflex and dose of thiopentone required was recorded. HR, SBP, DBP and MAP were recorded at various time intervals before and after intubation. Results: In group I, following laryngoscopy and intubation, the rise in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were found to be more compared to group II which was statistically significant (p<0.01).In addition Clonidine reduced the requirement of thiopentone and produced arousable sedation after extubation without any side effects like bradycardia and hypotension. Conclusion: Clonidine in the dose of 3µg/kg body weight given intravenously 15 minutes before laryngoscopy and intubation was seen to effectively attenuate the hemodynamic response to laryngoscopy and intubation without any side effects.

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Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study of Efficacy of Clonidine in Attenuating Haemodynamic Response to Laryngoscopy and Tracheal Intubation

Acharya¹,

Routray²

2017

AIMDR

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“…[21] Dose selection is in consensus with previous studies by Tripathi et al . [17] We chose to administer IM clonidine 60-90 min prior to induction and IV clonidine 15 min prior to induction. In view of the fact that, clonidine has a half-life of 8-12 hrs with peak effect achieved in 1-1.5 hrs after IM administration and 20 minutes after IV administration.…”

Section: Discussionmentioning

confidence: 99%

“…[7141516] There are few studies demonstrating the effectiveness of intravenous (IV)[1718] or intramuscular (IM)[1920] clonidine individually in attenuation of hemodynamic response during laparoscopy. However, there is limited literature, comparing the intravenous and intramuscular routes of clonidine premedicant in laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

The comparative evaluation of intravenous with intramuscular clonidine for suppression of hemodynamic changes in laparoscopic cholecystectomy

et al. 2013

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Background:Clonidine diminishes stress response by reducing circulating catecholamines and hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. The aim of this study was to compare intravenous (IV) clonidine (2 μg/kg) with intramuscular (IM) clonidine (2 μg/kg) for attenuation of stress response in laproscopic surgeries.Methods:Eighty adult patients classified as ASA physical status I or II, aged between 20 and 60 years undergoing elective cholecystectomy under general anesthesia were enrolled for a prospective, randomized, and double-blind controlled trial. They received either IV clonidine (2 μg/kg) 15 min prior to the scheduled surgery (Group I) or IM clonidine (2 μg/kg) 60-90 min prior to the scheduled surgery (Group II). Hemodynamic variables (Heart rate, systolic (SBP), diastolic (DBP), mean arterial pressure (MAP)), SpO2 and EtCO2 were recorded at specific times - baseline, prior to induction, 1 min after intubation, before CO2, insufflation, after CO2 insufflation at 1,5,10,20,30,45,60 min, after release of CO2, at 1 and 10 minutes after extubation. Secondary outcomes included evaluation of adverse effect profile of the two groups.Results:No significant difference was observed in the HR throughout the intraoperative period in between the two groups (P>0.05). There was statistically significant difference in SBP between the two groups starting from 1 minute after induction till 1 min after extubation (P<0.05) but not in DBP except at 1 minute after intubation (P=0.042). Significant difference in MAP was noted at 1 minute after intubation (P=0.004) and then from 5 minutes after CO2 insufflation to 1 minute after extubation (P<0.05). Incidence of adverse effects were higher in group II (P=0.02) especially incidence of hypertension requiring treatment (0.006).Conclusion:We conclude that under the conditions of this study, hemodynamic parameters (SBP, DBP and MAP) were better maintained in the IV as compared to the IM route that had significantly higher incidence of hypertension requiring treatment.

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“…Clonidine (category B-2). Clonidine is a centrally acting a agonist used to treat central pain syndromes; however, evidence suggests a useful role as an opioid-sparing medication with anesthesia and analgesia (Blaudszun, Lysakowski, Elia, & Tramer, 2012;Tripathi, Shah, Dubey, Doshi, & Raval, 2011). Studies document increased sedation when clonidine is added to opioid-based regimens (Huang et al, 2007;McCartney, Duggan, & Apatu, 2007;Vukovic, Ramakrishnan, & Milan, 2012) but no appreciable effects of clonidine in causing respiratory depression.…”

Section: Rationalementioning

confidence: 99%

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

Jungquist

Quinlan-Colwell

Vallerand

et al. 2020

Pain Management Nursing

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a b s t r a c tObjectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics. Design: Systematic review of the literature. Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews. Results: The 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated. Conclusions: All hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.

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Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication

Cited by 42 publications

References 13 publications

A Prospective Randomized Study of Efficacy of Clonidine in Attenuating Haemodynamic Response to Laryngoscopy and Tracheal Intubation

A Prospective Randomized Study of Efficacy of Clonidine in Attenuating Haemodynamic Response to Laryngoscopy and Tracheal Intubation

The comparative evaluation of intravenous with intramuscular clonidine for suppression of hemodynamic changes in laparoscopic cholecystectomy

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

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