Title: Evaluation of Effect of Infusion of Dexmedetomidine on Attenuation of Hemodynamic Response During Laparoscopic Surgeries

Authors: Dr S.D.Yennawar, Dr Nazima Y Memon, Dr N.K Nandanwankar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i6.08

Abstract

 Background: Laparoscopic Surgeries have recently gained much popularity because of its minimal invasiveness and fast recovery. These surgeries require creation of Pneumoperitoneum with carbon dioxide which results in undesirable hemodynamic effects. To overcome these effects various drugs have been tried. Recently dexmedetomidine, a selective α-2 agonist, is used for same purpose. Various studies have found that use of dexmedetomidine is associated with blunting of haemodynamic instability associated with creation of Pneumoperitoneum for the purpose of laparoscopic surgeries.

Aims and Objectives: The purpose of the study was (1) To study the effect of dexmedetomidine on attenuation of hemodynamic responses associated with Pneumoperitoneum during laparoscopic surgeries (2) To study the incidence of adverse effects like bradycardia, hypotension, and Postoperative nausea and vomiting (3) To study the effect on postoperative pain relief.

Material and Methods: The study included 60 patients of ASA grade I/II divided into two groups, Group A (n=30) Patients received Dexmedetomidine infusion 1mcg/kg/min over 10 minutes prior to induction followed by dexmedetomidine infusion at 0.3 mcg/kg/min till end of surgery. Group B (n=30) received normal saline infusion at same rate.

Conclusion: Patients receiving dexmedetomidine infusion had better hemodynamic profile without any significant side effects than patient receiving saline infusion. Also the requirement of analgesic in postoperative period was reduced significantly in dexmedetomidine group. Moreover incidence of adverse effects like bradycardia, hypotension and Postoperative vomiting was considerably less in patients who received dexmedetomidine.

Keywords: Laparoscopic surgery, Pneumoperitoneum, Dexmedetomidine, hemodynamic response.

References

1.      Blum CA, Adams DB. Who did the first laparoscopic cholecystectomy? Journal of Minimal Access Surgery. 2011;7(3):165-168.

2.      Litynski GS. Profiles in laparoscopy: Mouret, Dubois, and Perissat: The laparoscopic breakthrough in Europe (1987-1988) JSLS. 1999;3:163–7

3.      Bruhat MA, Chapron C, Mage G, Pouly JL, Canis M, Wattiez A, Glowaczower E. The benefits and risks of laparoscopic surgery]. Rev Fr Gynecol Obstet. 1993 Feb;88(2):84-8

4.      Pisarska M, Pędziwiatr M, Budzyński A. Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma. Gland Surgery. 2016;5(5):506-511.

5.      Sadhu S, Sarkar S, Jahangir TA, et al. Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction. The Indian Journal of Surgery. 2011;73(2):90-95.

6.      Srivastava A, Niranjan A. Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations. Journal of Minimal Access Surgery. 2010;6(4):91-94.

7.      Sha M, Kohno M, Yamagami J, Fujiwara Y, Hiroshima N, Kitahara M, Yamauchi K,Ohmura A. [Pulmonary complications following laparoscopic cholecystectomy in patients with abnormal spirometry]. Masui. 2001 Dec;50(12):1332-6.

8.      Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF. Diagnostic laparoscopy increases intracranial pressure. J Trauma. 1994 Jun;36(6):815-8;

9.      Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proceedings (Baylor University Medical Center). 2001;14(1):13-21.

10.  Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesthesia, Essays and Researches. 2011;5(2):128-133.

11.  Nguyen NT, Wolfe BM. The Physiologic Effects of Pneumoperitoneum in the Morbidly Obese. Annals of Surgery. 2005;241(2):219-226.

12.  Perugini RA, Callery MP. Complications of laparoscopic surgery. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001.

13.  Speicher PJ, Ganapathi AM, Englum BR, Vaslef SN. Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures. Surgery. 2014;156(2):371-378.

14.  Ntutumu R, Liu H, Zhen L, et al. Risk factors for pulmonary complications following laparoscopic gastrectomy: A single-center study. Zhang. L, ed. Medicine. 2016;95(32):e4567.

15.  Constantin JM, Momon A, Mantz J, Payen JF, De Jonghe B, Perbet S, Cayot S,Chanques G, Perreira B. Efficacy and safety of sedation with dexmedetomidine incritical care patients: a meta-analysis of randomized controlled trials. Anaesth Crit Care Pain Med. 2016 Feb;35(1):7-15.

16.  Bührer M, Mappes A, Lauber R, Stanski DR, Maitre PO. Dexmedetomidine decreases thiopental dose requirement and alters distribution pharmacokinetics. Anesthesiology. 1994 Jun;80 (6):1216-27.

17.  Hunter JC, Fontana DJ, Hedley LR, Jasper JR, Lewis R, Link RE, Secchi R, Sutton J, Eglen RM. Assessment of the role of alpha 2-adrenoceptor subtypes in the antinociceptive, sedative and hypothermic action of dexmedetomidine in transgenic mice. Br J Pharmacol. 1997;122:1339–1344.

18.  Aantaa R, Jaakola ML, Kallio A, Kanto J. Reduction of the minimum alveolarconcentration of isoflurane by dexmedetomidine. Anesthesiology. 1997 May;86(5):1055-60.

19.  Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia. 1997 Aug;52(8):736-44.

20.  Ge D-J, Qi B, Tang G, Li J-Y. Intraoperative Dexmedetomidine Promotes Postoperative Analgesia and Recovery in Patients after Abdominal Hysterectomy: a Double-Blind, Randomized Clinical Trial. Scientific Reports. 2016;6:21514. 

Corresponding Author

Dr Nazima Y Memon

Assistant Professor, Department of Anaesthesiology

Dr Shankarrao Chavan Government Medical College, Vishnupuri, Nanded (MS) India