Hemodynamic changes associated with laparoscopic cholecystectomy: Effect of oral clonidine premedication.

Abstract

Pneumoperitoneum required for laparoscopy results in pathophysiologic changes, especially in the cardiovascular system. Clonidine, an alpha 2 agonist has been shown to be effective in reducing perioperative hemodynamic instability. The aim of our study was to assess the hemodynamic changes during laparoscopic cholecystectomy and to find the effect of oral clonidine premedication in prevention of these hemodynamic responses.100 adult ASA I and II patients scheduled for elective laparoscopic cholecystectomy were selected for this prospective randomized double blinded comparative study. They were randomly allocated to one of the two groups to receive either oral clonidine 150 micrograms (Group C) or ranitidine 150 mg (group B) 90 minutes prior to induction of anaesthesia.When vital parameters were compared significant rise in heart rate, systolic, diastolic and mean blood pressure was noted in group B following pneumoperitoneum, where as in group C patients the rise if present was not more than 10% of baseline. Nitroglycerine drip was required in 28% of patients in group B to control intraoperative hypertension. Incidence of postoperative adverse events like nausea-vomiting, shivering and pain was also lower in patients who received clonidine premedication, though they appeared to be more sedated.In conclusion, clonidine premedication provides perioperative hemodynamic stability in ASA I and II patients undergoing laparoscopic cholecystectomy, and hence can be recommended as a routine premedication for laparoscopic procedure.