COMPARISON BETWEEN TWO DOSES OF DEXMEDETOMIDINE ON HEMODYNAMIC STRESS RESPONSE TO LARYNGOSCOPY PNEUMOPERITONEUM, SEDATION AND POST OPERATIVE ANALGESIA WHEN USED AS PREMEDICANT IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERIES.

Volume : VII, Issue : VIII, August - 2018

Uditi Parmar, Sonal Awasya

Background:The bene􀃶ts of laparoscopic surgeries include less pain,early mobilization,shorter hospital stay which

have further increased its applications.But during laparoscopic surgeries, CO2 is routinely used to create

pneumoperitoneum,which causes increased plasma levels of catecholamine and vasopressin.Elevation of intraabdominal pressure with

raised diaphragm causes adverse effects on cardiovascular system such as decreased cardiac output,elevated arterial pressure and

elevated systemic vascular resistence leading to hypertension and tachycardia.Hence drug which can blunt hemodynamic response to

laryngoscopy,intubation and pneumoperitoneum without any adverse side effect is required for this purpose.Dexmedetomidine is a alpha

2 adrenergic agonist which has properties of sedation,sympatholysis and analgesia without having any adverse side effects. .

AIM: PRIMARY OBJECTIVES:

1)To compare two doses of dexmedetomidine(0.50mcg/kg and 0.75mcg/kg) in attenuatuating stress response during laryngoscopy and

intubation in patients undergoing laparoscopic surgeries.

2)To compare the effects of two doses of dexmedetomidine in attenuating intraoperative hemodynamic changes during laparoscopic

surgeries.

3)To compare reduction in intraoperative analgesic requirements with two doses of dexmedetomidine used as premedicants.

SECONDARY OJECTIVES:

1)To study and compare the sedation score and duration of post operative analgesia with two different doses of dexmedetomidine.

2)To study the side effects and complications related to dexmedetomidine if any.

Material and Method: It was a randomized, prospective, double blinded, comparative hospital based study at Department of

Anaesthesiology, Gandhi Medical College, Bhopal. 60 ASA Grade I-II patients, age ranging from 18-60 years of either sex, scheduled for

laparoscopic surgeries were randomly allocated into three groups of 20 patients each:

Ÿ Group P(n=20): received 20 ml of normal saline as placebo over 10 minutes prior to induction.

Ÿ Group D(n=20): received i/v dexmedetomidine 0.5mcg/kg diluted upto 20ml with normal saline slowly over 10 minutes prior to

indution.

Ÿ Group M(n=20): received i/v dexmedetomidine 0.75mcg/kg diluted upto 20 ml with normal saline slowly over 10 minutes.

Results:There was signi􀃶cant decrease in mean HR and MAP in group M as compared to saline group and group D (Dxm=0.50mcg/kg)

through-out the surgery (P< 0.05) which shows that dexmedetomidine (0.75 mcg/kg/h) was effective in reduction of HR and BP due to

stress response of laparoscopic surgery and endotracheal intubation.

The duration of analgesia was signi􀃶cantly higher in the patients belonging to the Group M. Likewise, the average number of rescue

analgesic doses received by Group D patients were more compared to patients in Group M.

Conclusion: From our study we conclude that Dexmedetomidine 0.75μg/kg is signi􀃶cantly superior to Dexmedetomidine 0.50μg/kg in

attenuating hemodynamic respose to laryngoscopy ,pneumoperitoneum,sedation and postoperative analgesia when used as

premedicant in patients undergoing laparoscopic surgeries.