TO STUDY THE EFFECTS OF DIFFERENT STRENGTHS OF DEXMEDETOMIDINE INFUSION ON HEMODYNAMIC RESPONSES IN LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Background: Laparoscopic cholecystectomy is a minimally invasive procedure gaining popularity in the recent years. Open cholecystectomy procedures are more invasive with prolonged recovery, increased analgesic requirement, delayed gastric recovery and wound healing and increased pulmonary complications. Laparoscopic surgeries provide major benefits with faster recovery time, reduced postoperative pain and reduced hospital stay. Laparoscopic surgeries, require the creation of pneumoperitoneum using carbon dioxide along with patient positioning (Trendelenburg or reverse Trendelenburg) which causes physiologic changes which can be deleterious to patients with preexisting diseases. The changes occurring during laparoscopy can be attenuated using various drugs like vasodilating agents, alpha2 adrenergic agonists, opioids and beta blocking agents. This study was done to compare the efficacy of low dose infusion of dexmedetomidine using different strengths on attenuating the hemodynamic responses occurring in laparoscopic cholecystectomy. Sixty patients between 18 and 60 years of either sex belonging to ASAMethodology: grade 1 and 2 scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly allotted to one of the two groups of 30 each. Group DEX 0.2 received Dexmedetomidine at 0.2mcg/kg/hour and Group DEX 0.4 received Dexmedetomidine at 0.4mcg/kg/hour 15 minutes prior to induction. Haemodynamic variables were recorded at baseline, post intubation, aftercreation of pneumoperitoneum and after extubation. Other parameters noted were VAS score, RSS score and time to first supplementation of rescue analgesic. In both the groups there was a rise in theResults: mean arterial pressure and heart rate post intubation and after creation of pneumoperitoneum from the baseline. But the rise was considerably lower in DEX 0.4 group. After 30 minutes of pneumoperitoneum, there was a considerable fall in the heart rate and mean arterial pressure in the DEX 0.4 group. There was no difference in the time for extubation in both the groups. The postoperative analgesic requirements were lesser in DEX0.4 group. No significant side effects were noted. Low dose dexmedetomidine as an infusion started 15 minutes prior to induction does notConclusion: completely attenuate the stress response to intubation and pneumoperitoneum. In comparison, o.4mcg/kg/hour of Dexmedetomidine provides better response than 0.2mcg/kg/hour.