Comparison of Effect of Clonidine and Magnesium Sulphate on Attenuation of Haemodynamic Response to CO2 Pneumoperitoneum in Patients Undergoing Laparoscopic SurgeriesA Randomised Clinical Study

Abstract

Introduction: Laparoscopy, a minimally invasive technique causes several physiological fluctuations. There can be deleterious sympathetic responses during carbon dioxide insufflation, which is done to create a pneumoperitoneum. Aim: To assess the impact of clonidine and magnesium sulphate on sympathetic response to carbon dioxide insufflation in patients undergoing laparoscopic surgeries. Materials and Methods: A double-blinded randomised clinical study was conducted in Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharshtra, India, from June 2020 to September 2021, included 52 patients, posted for elective laparoscopic surgeries. Patients were randomized into two groups i.e, group M (n=26) received 30 mg/kg of magnesium sulphate and group C (n=26) received 1 μg/kg of clonidine after premedication. The vital parameters like heart rate, systolic, diastolic and mean arterial pressure, end tidal carbon dioxide, saturation were observed and noted at predetermined interval in perioperative period. Also, Visual Analogue Score (VAS) and sedation score were recorded in the recovery room. The statistical software SPSS version 16 was used. The p-value <0.05 was considered as significant. Results: The mean age in group C and group M was 35.46± 8.5 years and 35.38±9.02 years (p-value=0.751). Both groups were compared for change in heart rate, systolic, diastolic and mean blood pressure changes after pneumoperitoneum and showed no significant variations in both groups at different time intervals (p-value >0.05). Also, both groups showed less than 20% variation from the baseline parameters, thus, effectively attenuating the pressor response. The VAS and sedation score were comparable in both the groups and showed no significant variations in both groups at different time intervals. Conclusion: Intravenous administration of clonidine 1 μg/kg, or magnesium sulfate 30 mg/kg prior to pneumoperitoneum was effective in suppressing the pressor response during laparoscopic procedures. At the above used dosages, groups C and M showed insignificant difference in the measured parameters, thus proving to be equally effective in blunting the pressor response.