ABSTRACT
Objective
To evaluate the efficacy of single bolus dose of xylocard before induction to provide perioperative hemodynamic stability in patients undergoing laparoscopic cholecystectomy.
Patients and Methods
Fifty patients of either sex, 18-65 years of age, undergoing elective laparoscopic cholecystectomy were randomly allocated in one of the two groups comprising of 25 patients each. Group D received intravenous xylocard 1.5 mg/kg body weight five minutes before induction and Group S received 0.9% saline in the same volume with a similar syringe by a different observer. Changes in mean arterial pressure, heart rate and recovery time of the patients were observed at different intervals.
Results
Mean arterial pressure and heart rate in Group D were significantly lower after intubation and throughout the period of pneumoperitoneum than the Group S. No significant difference in the parameters of recovery were observed between the two groups.
Conclusion
Pretreatment with xylocard improves intra and post-operative hemodynamic stability during laparoscopic surgery without prolongation of recovery.
Keywords
Xylocard, laparoscopy, pneumoperitoneum.
INTRODUCTION
In 1940, Reid & Brace first described the hemodynamic response to laryngoscopy and intubation.1 As these changes may be fatal in some patients, to attenuate these responses various methods including adrenergic blockers, vasodilators, calcium channel blockers and -2 agonist have been tried.2 Narcotics and inhalational anesthesia too may obtund these responses by increasing depth of anesthesia. Xylocard also provides improved hemodynamic stability during intraoperative period.
Pneumoperitoneum produced by administration of carbon dioxide (CO2) during laparoscopic surgical procedures,3 cause adverse cardiovascular effects.4 Some of these effects are related to CO2 and some are due to cephaloid movement of the intra¬abdominal content pressing upon diaphragm. Immediately after pneumoperitoneum, plasma levels of norepinephrine, epinephrine and plasma renin activity increase.5 These changes contribute to elevated arterial pressure, increased systemic and pulmonary vascular resistance and reduced cardiac output.6 Apart from that, laparoscopic cholecystectomy (LC) is performed in reverse Trendelenburg position, which leads to diminished venous return and thereby further reduction in cardiac output.7 This placebo controlled, double blind prospective study was designed to evaluate the efficacy of xylocard to provide hemodynamic stability in patients undergoing LC.
PATIENTS AND METHODS
Fifty ASA grade I and II patients, aged 18-65 years, undergoing elective LC were randomly assigned to two groups (each containing 25 patients): Group D (Xylocard group) and Group S (Control group). Patients with hypertension, morbid obesity and with severe hepatic, renal, endocrine and cardiac dysfunction were excluded from the study. Informed consent was taken from all patients.
On a
Key words: Xylocard, laparoscopy, pneumoperitoneum.
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