Attenuation of Haemodynamic Parameters in Response to Pneumoperitoneum during Laparoscopic Cholecystectomy: A Randomized Controlled Trial Comparing Infusions of Propofol and Dexmedetomidine UC01-UC04
Dr. Meyong Pincho Bhutia,
Assistant Professor, Department of Anaesthesia, Sikkim Manipal Institute of Medical Sciences, Gangtok-737102, Sikkim, India.
Introduction: Effective control of sympathetic response to pneumoperitoneum is vital to avoid morbidity in patients undergoing laparoscopic surgeries. This control must be achieved without any side effects of the drugs being used as well as ensuring a raid recovery from anaesthesia in order to maximise operation theatre utility.
Aim: To study the effectiveness of dexmedetomidine in attenuating the haemodynamic response to pneumoperitoneum during laparoscopic cholecystectomy (using only the maintenance dose) with that of propofol and compare time to extubation, haemodynamics on extubation, sedation score after extubation and any incidence of side effects between the two study drug.
Materials and Methods: Sixty American Society of Anaesthesiologist (ASA) I and II patients undergoing laparoscopic cholecystectomy between age of 20-60 years were randomly divided into two groups of 30 patients each: Group D to receive dexmedetomidine in dose of 0.2-0.7 µg/kg/hr titrated as per clinical response and Group P to receive propofol in dose of 25-75 µg/kg/min (1.5-4.5 mg/kg/hr) titrated as per clinical response after standard anaesthetic induction. Data recording was done for changes in haemodynamic parameters, time to extubation and post extubation sedation score. Statistical analysis was done using students-test and Chi-square test with p-value of< 0.05 was considered significant.
Results: Attenuation of haemodynamic parameters by dexmedetomidine during the intraoperative period even without the loading dose was comparable to that by propofol (p-value >0.05). Time to extubation was similar in both the groups (p-value >0.05). Haemodynamics on extubation was better controlled in dexmedetomidine group (p-value <0.05) while the sedation score was better in propofol group (p-value <0.05). Mean dose of dexmedetomidine and propofol used were 0.504±0.09 µg/kg/hr and 3.19±0.7 mg/kg/hr respectively.
Conclusion: Dexmedetomidine in a dose of 0.2-0.7 µg/kg/hr provides a stable haemodynamics without any side effects in patients undergoing laparoscopic cholecystectomy.