EFFECTS OF LOW DOSE DEXMEDETOMIDINE INFUSION ON HAEMODYNAMIC STRESS RESPONSE, SEDATION AND POST OPERATIVE ANALGESIA REQUIREMENT IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERIES

Dr.S. Ramadevi; Dr. C. Chitra; Dr. Jeremiah Kharshiing

Volume : VIII, Issue : II, February - 2018

EFFECTS OF LOW DOSE DEXMEDETOMIDINE INFUSION ON HAEMODYNAMIC STRESS RESPONSE, SEDATION AND POST OPERATIVE ANALGESIA REQUIREMENT IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERIES

Dr. S. Ramadevi, Dr. C. Chitra, Dr. Jeremiah Kharshiing

Abstract :

BACKGROUND – Dexmedetomidine is a selective alpha–2 agonist which has sedative and analgesic properties. It is a useful drug to blunt the haemodynamic stress response of the patients undergoing stress related surgeries.The aim of my study was to evaluate the use of this drug in compå the two low dose infusions (0.2 mic/kg/hour and 0.4mic/kg/hour ) and a control group using normal saline .

AIM–To compare the effects of low dose 0.2 mic/kg/hr & 0.4 mic/kg/hr Dexmedetomidine infusion on haemodynamic stress response to maneuvers like;Laryngoscopy ,Endotracheal intubation, Creation of pneumoperitoneum , Extubation and Sedation .Also the postoperative analgesia requirement in patients undergoing laparoscopic surgeries.

METHODS– 60 patients were taken of American society of anaesthesiologist physical status (ASAPS ) I and II , undergoing laparoscopic surgeries. 3 groups were taken ,each of 20 patients each .Group J receiving dexmedetomidine infusion of 0.4 mic/kg/hr, Group K receiving dexmedetomidine infusion of 0.2 mic/kg/hr and Group L (control group) receiving normal saline infusion only. Parameters were noted such as MAP (Mean arterial pressure ), PR ( Pulse Rate) , oxygen saturation The drug infusion was started 15 minutes before induction till the specimen was taken out . The Post operative requirement and rescue analgesia were also noted. The results were statistically analyse using SPSS v 16.0 . ANOVA test fo rcontinuous variable ( p value) , post hog test for intergroup comparison and chi square tests for discrete values were applied.

MATERIALS–Infusion syringe pump with 20 cc syringe,injection Dexmedetomidine 50 mcg /0.5 ml, boyle’s apparatus for providing general anaesthesia ,working Laryngoscope, cuffed endotracheal tubes of appropriate size, airway, suction apparatus with a suction catheter, emergency drugs such as inj. Adrenaline, inj. Atropine, inj. Ephedrine , monitor for continuous monitoring of non – invasive blood pressure (NIBP), Electroencephalography (ECG), Pulse Rate (PR), Respiratory Rate(RR) ,Oxygen saturation (Sp02).

RESULTS–Haemodynamic stress response to laryngoscopy, intubation, creation of pneumoperitoneum , release of pneumoperitoneum,and extubation was attenuated in groups J receiving 0.4mic/kg/hr with no post operative adverse effects like rebound hypertension , adycardia , vomiting and headache. Post operative analgesia for and rescue analgesia requirement was also minimal.

CONCLUSION– Low dose of Dexmedetomidine of 0.4mic/kg/hr compared to 0.2 mic/kg/hr was found to be better in maintenance of the haemodynamic stability in patients undergoing laparoscopic surgeries. Moreover the post operative requirement of rescue analgesics is also significantly lower in 0.4 mic/kg/hr (Group J) than 0.2 mic/kg/hr.(Group K ).Hence, 0.4 mic/kg/hr infusion of Dexmedetomidine is the ideal dose to attenuate the stress response in laparoscopic surgeries.