ALPHA 2 AGONISTS AS AN ADJUVANT TO ANAESTHESIA DURING LAPAROSCOPIC SURGERY: A COMPARATIVE STUDY TO ASSESS HAEMODYANAMIC CHANGES

Abstract

Background - Laparoscopy surgeries offer many advantages over open surgeries.
But pneumoperitoneum created by CO2 insufflation during laparoscopic procedures
affects several homeostatic systems leading to alteration in cardiovascular,
pulmonary physiology and stress responses, acid-base balance. Amongst which
cardiovascular changes may be detrimental hence to obtund intubation and CO2
insufflation/stress response alpha agonist clonidine and dexmedetomidine can be
used as adjunct.
Methodology – It was comparative study conducted over 15 months in the
Department of Anaesthesiology at a tertiary care hospital, amongst 90 adult patients
of age group 18-50 years of either gender, ASA I-II undergoing elective surgical
procedures under general anaesthesia. Patients were randomized into three groups as
Group D (inj. Dexmedetomidine 1ucg/kg), Group C (inj. Clonidine 1ucg/kg) both in
in 10 ml NS and Group S (10 ml NS) for use of pretreatment drugs to be given
slowly over 15 mins.
Results - Demographic parameters were noted and found comparable. During
laparoscopic surgeries stress points are laryngoscopy and insufflation both alpha 2
agonist supressed haemodynamic responses compared to group S that is placebo.
After intubation changes seen in heart rate were group D (88.43 ± 15.776) beats/ min
and group C (88.43 ± 15.776) beats/ min compared to group S (97.7 ± 14.686) beats/
min. Another stress point such as creation pneumoperitoneum, compared to baseline
values mean arterial pressure changes were prevented in group D (92.2 ± 10.223)
mmHg and group C (89.43 ± 11.825) mmHg as compared to group S (100.4 ±
10.731) mmHg. Similar results were seen for SBP and DBP. Requirement of
inhalational agents was reduced in Group D and C compared to S.
Conclusion - Both α 2 agonists were found to be effective in attenuating the
hemodynamic response to pneumoperitoneum during laparoscopic surgeries and also
provided sedation when used as a premedication agent.