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Category: Volume 08 Issue 04 April 2020
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Title: A comparative study of magnesium sulphate and clonidine in attenuating hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy

Authors: Anita Pareek, Jinesh Baid, Kiwi Manthan, Aditya Sharma

 DOI: https://dx.doi.org/10.18535/jmscr/v8i4.89

Abstract

 

Introduction: Laparoscopic cholecystectomy is one of the most common laparoscopic surgeries performed worldwide. Pneumoperitoneum is commonly induced by carbon dioxide (CO2). Pneumoperitoneum affects homeostasis and leads to alterations in cardiovascular, pulmonary physiology and stress response. Pneumoperitoneum, as well as hypercapnia due to CO2, is responsible for the adverse cardiovascular effects. An abrupt elevation of mean arterial pressure, systemic vascular resistance and decreased cardiac output are commonly noted. This vasopresso responses are due to hypercarbia induced release of both catecholamines and vasopressin. Our aim was to evaluate and compare the effect of intravenously administered clonidine and magnesium sulfate for attenuating the hemodynamic responses to pneumoperitoneum during laparoscopic surgeries.

Material & Methodology: We conducted a prospective double blinded randomized control study in 90 patients belonging to ASA I and II undergoing elective laparoscopic surgeries in S. P. medical college, Bikaner after taking approval from Institutional Ethical committee and valid written informed consent from patients and their close relatives. Patients of both sexes ranging between 18 to 60 years of age were included.

Patients were divided randomly using computer-derived random number sequence into three groups of 30 each. Group-C received clonidine 1.0μg/kg in 50 ml of normal saline. Group-M received magnesium 50mg/kg in 50 ml of normal saline. Group-NS received 50 ml normal saline.

The test drug solution was given after intubation and before pneumoperitoneum. The HR, SBP, DBP, MAP were noted.

Results: In both magnesium and clonidine groups, there was no statistically significant differences observed in SBP, DBP, MAP ( p-value > 0.05) (statistically significant fall in HR between the group-M and group-C) but as compared to group-NS there was significant difference ( p-value < 0.05) in hemodynamic parameters. In group-NS haemodyamic parameters were comparatively high as compared to other two groups.

Conclusion: Clonidine 1.0 μg/kg was equally effective as magnesium shulphate 50mg/kg in blunting the hemodynamic stress response during laparoscopic surgeries as compared to normal saline group where haemodyamic parameters were comparatively high.

Keywords: Magnesium shulphate, Clonidine, Laparoscopic cholecystectomy.

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Corresponding Author

Jinesh Baid

Department of Anaesthesia, Sardar Patel Medical College& AGH, Bikaner, Rajasthan, India