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

Abstract

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.

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

“…Based on studies by others with different doses and route we aimed to use 1.5 mcg/kg of IV clonidine with fentanyl 1.5 mcg/kg as premedication for general anaesthesia to observe the effects on stress responses and found to have significant haemodynamic stability in patients who received clonidine infusion as premedication, as observed by others. [20][21][22] Due to attenuation of stress responses lesser need of use of drugs like esmolol, labetalol and nifedipine, clonidine thus also minimizes the requirement of intraoperative analgesics and inhalational agent almost by 30% which is observed on study by Sung et al 15 We also observed lesser need of nitroglycerine infusion in patients of clonidine pre-medicated group. M Laisalmi et al 23 in their study with 4.5 mcg/ kg of clonidine on neuroendocrine response and renal parameters by measuring plasma renin activity (PRA), serum anti-diuretic hormone (ADH), urine N-Acetyl-beta-D-glucosaminidase and creatinine levels and oxygen tension of the urine peri-operatively.…”

“…Chiruvella et al 21 studied IV 1 mcg/kg of dexmedetomidine and clonidine for attenuation of stress responses during laparoscopic cholecystectomy and found dexmedetomidine more effective than clonidine however chances of hypotension and bradycardia were more with dexmedetomidine. Singh M et al 22 studied 2 mcg/kg of IV clonidine with 2 mcg/kg intramuscular clonidine injection as premedication and found better haemodynamic stability (MBP,HR) in patients receiving clonidine by IV route and more patients required treatment for hypertension who received intramuscular clonidine as premedication. Based on studies by others with different doses and route we aimed to use 1.5 mcg/kg of IV clonidine with fentanyl 1.5 mcg/kg as premedication for general anaesthesia to observe the effects on stress responses and found to have significant haemodynamic stability in patients who received clonidine infusion as premedication, as observed by others.…”

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

“…Many studies have shown effectiveness of intravenous clonidine in attenuation of hemodynamic response during laparoscopy 1,3,5 Intrathecal clonidine used as adjuvant for bupivacaine during laparoscopic cholecystectomies shown prolonged post-operative analgesia and sedation. 6 Clonidine through i.v route has been used as a single dose prior to induction or as continuous infusion throughout laparoscopic procedures.…”

A Comparative Study of Dexmedetomidine and Esmolol on Hemodynamic Responses During Laparoscopic Cholecystectomy

“…Increased release of vasopressin, catecholamines, or both are responsible for these hemodynamic responses [2,3,4]. Various drugs like nitroglycerine [5], beta blockers [6], opioids [7], gabapentin [8], pregabalin [9], magnesium sulphate [10], clonidine [11] and dexmedetomidine [12] are used to provide hemodynamic stability during pneumoperitoneum with variable success rate. Dexmedet-omidine inhibits the release of catecholamines and vasopressin, thus modulating the hemodynamic changes induced by pneumoperitoneum [12][13].…”