Email this article A comparative study for efficacy and safety of low doses of clonidine for hemodynamic stability in patients undergoing laparoscopic cholecystectomy
Abstract
Background: This randomized prospective double-blind study was designed to evaluate the efficacy and side effects of low doses clonidine for perioperative haemodynamic stability and postoperative recovery.
Methods: Patient’s with ASA grade I–II undergoing laparoscopic cholecystectomy were randomized into three groups of 30 patients each. All patients received either normal saline 10 ml (Group I) or 0.8 µg/kg (Group II) or 1 µg/kg (Group III) over duration of 180 seconds, 10 min prior to laryngoscopy and intubation. Anaesthesia was induced with 1% propofol (2 mg/kg) and maintained with nitrous oxide 60% in oxygen and isoflurane. The parameters assessed at various time intervals were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and sedation score.
Results: Both doses of clonidine proved to be effective in perioperative haemodynamic stability. Clonidine 0.8 mcg/kg was as effectve and safer to Clonidine 1 mcg/kg for attenuatíon of the hemodynamíc responses to laparoscopy. There were no significant differences in the parameters of recovery between groups.
Conclusions: Significant hemodynamic derangements can occur during laproscopic cholecystectomy at intubation, pneumoperitoneum and extubation. These were effectively attenuated by premedication with 0.8 mcg/kg and 1 mcg/kg of intravenous clonidine. Dose of 1 mcg/kg though found to be effective but produced adverse effects in form of hypotension and bradycardia.
Keywords
Full Text:
PDFReferences
Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, et al. Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ. 1998;317:103–10.
Stoelting RK. Attenuation of blood pressure response to laryngoscopy and tracheal intubation with Sodium Nitroprusside. Anesthesia Analgesia. 1979;58:116-9.
Fossoulaki A, Kaniasis P. Intranasal administration of Nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea. Br J Anaesth. 1983;55:49-52.
Prys-Roberts C, Foex P, Biro GP. Studies of anaesthesia in relation to hypertension versus adrenergic β receptor blockade. Br J Anaesth. 1973;45:671-80.
McCammon RL, Hilgenberg JC, Stoelting RK. Effect of Propranolol on circulatory responses to induction of diazepam- nitrous oxide anesthesia and to endotracheal intubation. Anesthesia analgesia. 1981;60(8):579-83.
Chung KS, Sinatra RS, Chung JH. The effect of an intermediate dose of Labetalol on heart rate and blood pressure responses to laryngoscopy and intubation. J Clin Anaesthesia. 1992;4(1):11-5
Donlinger, JK Ellison N, Ominsky AJ. Effects of intrathecal lidocaine an circulatory responses to tracheal intubation. Anaesthesiology. 1974;41:409-12.
Stoelting RK. Blood pressure and heart rate changes during short duration laryngoscopy for tracheal intubation: influence of viscous or intravenous lignocaine. Anaesthesia Analgesia. 1978;57:197-9.
Dahlgreen N, Messeter K. Treatment of the stress response to laryngoscopy and intubation with Fentanyl. Anaesthesia. 1981;36:1022-6.
Ebert JP, Pearson JD, Gelman S, Harris C, Bradley EL. Circulatory response to laryngoscopy. The comparative effects of Placebo, Fentanyl and Esmolol. Canadian J Anaesthesia, 1989;36:301-6.
Laisalmi M, Koivusalo AM, Valta P, Tikkanen I, Lindgren L. Clonidine provides opoid sparing effect, stable hemodynamics and renal integrity during laproscopic cholecystectomy. Surg Endosc. 2001;15:1331-5.
Ravol DL, Mehta MK. Oral clonidine premedication for attenuation of hemodynamic response to laryngoscopy and intubation. Indian J Anaesth. 2002;46:124-9.
Ramsay MA, Savege TM. Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. BMJ. 1974;2:656–9.
Nayek SK, Sengupta M, Paul KK, Bhattacharjee DP, Paul S. Effects of clonidine on hemodynamic stability patients undergoing laproscopic cholecystectomy- a comparative study. IJPCBS. 2013;3(3):610-4.
Chandrashekaraih MM, Upadya M, Jayachandran SP, Wali M. Effects of clonidine premeication on hemodynamic changes during laproscopic cholecystectomy- a randomized controlled study. Applied Cardiopulmonary Pathophysiol. 2011;15:91-8.
Kalra NK, Verma A, Agarwal A, Pandey HD. Comparative study of intravenously administered clonidine and magnesium sulphate on hemodynamic responses during laproscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2011;27(3):344-8
Zalunardo MP, Zollinger A, Spahn DR, Seifert B. Pre-operative clonidine attenuates stress response during emergence from anaesthesia. J Clin Anaesthesia. 2000;12(5):343-9.
Zalunardo MP, Zollinger A, Szelloe P, Spahn DR. Cardiovascular stress protection following anaesthesia induction. Comparison of clonidine and esmolol. Anaesthesist. 2001;50(1):21-5.
Altan A, Turgut N, Yildiz F, Turkmen A, Ustiin H. Effects of magnesium sulphate and clonidine on propofol consumption, haemodynamics and postoperative recovery. Br J Anaesthesia. 2005;93(4):438-41.
Ray M, Bhattacharjee DP, Hajra B, Pal R, Chatterjee N. Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recovery: A comparative study. Ind J Anaesth. 2010;54:137-41.
Westfall TC, Westfall DP. Adrenergic agonists and antagonists. In: Brunton L, Chabner B, Knollman B (eds). Goodman & Gillman’s The pharmacological basis of therapeutics. 12 ed. Newyork; McGraw Hill; 2011: 295-296.
