Efficacy of different doses of Dexmedetomidine on hemodynamic response during laparoscopic cholecystectomy under general anaesthesia: A prospective analytical study.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 1
Abstract
Laparoscopy or keyhole surgery became the gold standard since the introduction of laparoscopic cholecystectomy in mid-eighties, in managing the symptomatic gall stone diseases. Early mobilization, reduced hospital stay and decreased analgesic requirement besides improved cosmesis are its major benefits. However, the problems are primarily because of insufflation of carbon dioxide and positioning during surgery causing sympathetic over-stimulation. Increased systemic vascular resistance due to Pneumo-peritoneum induced hypercarbia causes tachycardia, hypertension and reduction in cardiac output1,2. Hemodynamics are further compromised by anaesthetic procedures like laryngoscopy, intubation and extubation 3. Severely altered hemodynamics during laparoscopy pose spectrum of management challenges to the anaesthesiologist. Several modifications viz. pharmacological agents (nitroglycerine4, beta blockers5, opioids6, gabapentin7, pregabalin8, magnesium sulphate9, clonidine9 and dexmedetomidine10) and regional anaesthesia 11 have been used to attenuate these changes11with variable success. Dexmedetomidine, a selective α2-adrenoreceptor agonist and an analogue of clonidine utilizes receptors distinct from γ-amino butyric acid (GABA) receptor used by benzodiazepines and propofol12. Being a selective α2 receptor agonist with sedative and analgesic effects but minimal respiratory depression, it has been widely used for sedation during mechanical ventilation, short procedures and postoperative anxiolysis to prevent emergence agitation and treatment of substance withdrawal10. Dexmedetomidine has properties of analgesia, sympatholysis and titratable sedation without major side effects12. It also reduces stress response to surgery ensuring a stable hemodynamic state and also lessens the opioid requirement and their side effects. It has a very short distribution half-life of approximately 6 min, so can be used successfully even for attenuating the stress response of laryngoscopy13. The present study was aimed to evaluate the effective dose of Dexmedetomidine and compare its two different regimes in attenuating the hemodynamic changes taking place during laparoscopic cholecystectomy under general anaesthesia.
Authors and Affiliations
Dr Manoj Kumar Sharma
Keywords
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