Background: Pneumoperitoneum created during laparoscopy affects several homeostatic systems leading to alteration in cardiovascular, pulmonary physiology, and stress response. Clonidine, α2 adrenergic receptor agonists, has the property of good anxiolysis, sedation, and analgesic action. Clonidine prevents the hemodynamic response to intubation.
Objectives: To study the response of oral clonidine premedication on hemodynamic changes during laparoscopy at various stages.
Materials and Methods: A prospective randomized controlled study of 60 patients undergoing laparoscopic cholecystectomy was carried out at Medical College and S. S. G. Hospital, Baroda during years 2006 to 2008. They were divided into two groups of which Group CL premedicated with tablet Clonidine 3 μg/kg, 90 min before induction while Group C were not given any oral premedication. All hemodynamic parameters were observed intraoperatively and for 2 h postoperatively.
Results: Demographic data in terms of age, sex, weight, height, and American Society of Anesthesiologists grade were comparable in both groups. Preoperative baseline parameter, i.e., pulse, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate and SpO2 were comparable in both groups. Pulse rate varied from 76.2 ± 7.015 bpm to 88.3 ± 5.4 bpm in Group CL and it varied from 86.7 ± 4.78 bpm to 112.93 ± 5.13 bpm in Group C. SBP varied from 110.8± 9.1 mmHg to 128.13 ± 5.7 mmHg in group CL while it varied from 128.33 ± 6.59 mmHg to 159.6 ± 12.33 mmHg in Group C. DBP varied from 78.53 ± 3.44 to 83.93 ± 4.85 in group CL while it varied from 82.13 ± 3.23 to 99.47 ± 9.01 in Group C. Requirement of isoflurane to maintain MAP intraoperatively was 40% less in Group CL than Group C. There was no significant change seen in SpO2 in both groups and no fall in SpO2 seen intraoperatively in both groups. After 90 min of giving clonidine premedication in Group CL, all patients had sedation score of 2 while no sedation was found in patients of Group C. Only 2 patients (6.6%) in Group C had nausea, and one patient (3.3%) of Group CL had subcutaneous emphysema postoperatively. No other complications observed intra- or post-operatively which did not require any treatment. All patients of Group CL had dryness of mouth.
Conclusion: With clonidine 3 μg/kg there is no rise in pulse rate and BP throughout laparoscopic cholecystectomy at various stages. Patients remain haemodynamically stable throughout laparoscopic surgery with clonidine. Clonidine also decreased the requirement of inhalation agent. No significant perioperative complications were found with the use of clonidine.
Key words: Oral Clonidine; Pre-anesthetic Medication; Hemodynamic Changes; Laparoscopic Cholecystectomy
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