Title: IV Clonidine Premedication in Laparoscopic Surgery

Authors: Dr Rushikesh C Desai, Dr P V Bhale, Dr Vasanti P. Kelkar, Dr Shrinivas L Sangnoor, Dr Narendra Bhandari, Dr Ansul R.Udiavar

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i10.30

Abstract

 INTRODUCTION

Patients comfort is a great concern in 21st century. Minimal access surgical procedures produce less trauma with potential advantage of reduced post operative pain compared to open procedures, shorter hospital stays, more rapid return to normal activities and is cost effective than conventional open procedures.

Extensive endoscopic procedures are now performed in all patients with various co-morbidities. The development of minimally invasive surgery (MIS) has not only revolutionalized surgery but this process has also influenced the practice of anaesthesiology.1

Laparoscopic operative techniques involve insufflation of carbon dioxide (Co). Gases like helium, air can also be used. The operation table is tilted to 15 degree reverse trendelenburg for upper abdominal surgery like cholecystectomy. Techniques for pneumoperitoneum creation include insufflations after insertion of veress needle at infraumbilical region. 1

It is important that anaesthetic approaches are developed to ensure that these techniques are safe and associated with minimal complications and rapid recovery. The important physiological changes associated with laparoscopy are due to pneumoperitoneum (PNO) and positioning2

During the laparoscopic cholecystectomy there is reduced venous return, left ventricular end diastolic (LVED) pressure is reduced, intrathoracic pressure is increased, right atrial and pulmonary artery occlusion pressure (PAOP) increased  during insufflations. 3

References

1.      Moynihan GA. The Gall Bladder and Bile Ducts In: Bailey and Love’s - Short  Practice  of  Surgery. 24th  ed.,  Hachette  UK:  Hodder  Arnold  Publications; 2004.

2.      Antony C, Noreen D. Intraabdominal laparoscopic Surgery; Anaesthetic Implications  in  Wylie  and  Churchill  Davidsons -  A  practice  of  Anaesthesia. 7th ed., London: Hodder Arnold Publications; 2003.

3.      Sung CS, Lin SH, Chan KH, Chang WK, Chow LH, Lee TY. Effect of  oral clonidine premedication on perioperative hemodynamic response and  postoperative analgesic requirement for patients undergoing laparoscopic  cholecystectomy. Acta Anaesthesiol Sin. 2000; 38(1): 23-9.

4.      Sood J, Jayaraman L, Kumra VP. Historical Forum Endoscopic Surgery  Anaesthetic Challenges - A Historical Review. Indian J Anaesth 2006; 50  (3): 178-82.

5.      Ott DE. Chapter 1. Pneumoperitoneum: Production, Management, Effects  and Consequences. Prevention and management of the laproendoscopic  surgical procedures. 1st ed., Miami: Society of Laparoscopic surgeons; 2006.

6.      Rademaker BM, Odoom JA, de Wit LT, Kalkman CJ, ten Brink SA,  Ringers J. Haemodynamic effects of pneumoperitoneum for laparoscopicsurgery : A comparison of CO2 with N2O insufflation. Eur Anaesthesiol  1994; 11(4): 301-6.

7.      Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML. Hemodynamic  Changes   During   Laparoscopic   Cholecystectomy   Anesthesia   and  Analgesia 1993; 76: 1067-71.

8.      Singh S, Arora K. Effect of oral clonidine premedication on perioperative  hemodynamic  response  and  postoperative  analgesic  requirement  in  patients under going laparoscopic Cholecystectomy. Indian J Anaesth  2011; 55: 26-30.

9.      Passi Y, Raval B, Rupakar VB, Chadha IA. Effect of oral clonidine  premedication   on   haemodynamic   response   during   laparoscopic  cholecystectomy. J Anaesth Clin Pharmacol 2009; 25(3): 329-32.

10.  Das   M,  Ray   M,  Mukherjee  G.  Haemodynamic   Changes  During  Laparoscopic  Cholecystectomy:  Effect  Of  Clonidine  Premedication.  Indian J Anaesth 2007; 51(3): 205-10.

11.  O Leery E,Hubbard  K, Tormey W.Cuningham AJ –Laparoscopic  cholecystectomy:Hemodynamic &neuroendocrine response after pneumoperitoneum & changes in position. Br. J.Anaesthesia 1996,74:640-4.

12.  De Kock M, Laterre PF, Van Obbergh L, Carlier M, Lerut J. The effects  of   intraoperative   intravenous   clonidine   on   fluid   requirements hemodynamic  variables,  and  support  during  liver  transplantation: a prospective, randomized study. Anesthesia and Analgesia. 1998; 86: 468- 76.

13.  Málek J, Knor J, Kurzová A, Lopourová M. Advers hemodynamic changes   during   laparoscopic   cholecystectomy   and   their possible  suppression with clonidine premedication. Comparison with intravenous  and intramuscular premedication. Rozhl Chir 1999; 78 (6): 286-91.

14.  Yotsui T. Clonidine premedication prevents sympathetic hyperactivity but  does   not   prevent   hypothalamo-pituitary-adrenocortical   responses   in  patients  undergoing  laparoscopic  cholecystectomy.J Anesthesiology  2001; 15: 78-82.

15.  Abi-Jaoude F, Brusset A, Ceddaha A, Schlumberger S, Raffin L, Dubois  C, et al. Clonidine premedication for coronary artery bypass grafting under high-dose alfentanil anesthesia: Intraoperative and postoperative  hemodynamic study. J Cardiothoracic Vasc Anesth. 1993; 7: 35-40.

16.  Taittonen MT, Kirvelä OA, Aantaa R, Kanto JH. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption  and haemodynamic state. Br J Anaesth 2009; 78: 400-6.

17.  Boussofara M, Bracco D, Ravussin P. Comparison of the effects of clonidine   and   hydroxyzine   on   haemodynamic   and   catecholamine  reactions to microlaryngoscopy. Eur J Anaesthesiol 2001; 18: 75-8.

18.  Javaherfroosh F, Raza M, Pipelzadeh, Namazi M. Clonidine reduces post  operative nausea and vomiting in laparoscopic gynecological surgery. Pak  J Med Sci 2009 (Part-I); 25: 782-5.

19.  Marashi MS, Ghafari MH, Saliminia A. Attenuation of haemodynamic  responses following laryngoscopy and tracheal intubation. Middle Eur J Anaesth 2009; 20: 232-6.

20.  Talebi H, Nourozi A, Fateh S, Mohammadzadeh A, Eghtesadi-Araghi P, Jabbari S, et al. Effects of oral clonidine premedication on haemodynamic  response to laryngoscopy and tracheal intubation Pak J Biol Sci 2010; 13: 1146-50.   

21.  Raval DL, Mehta M. Oral clonidine premedication for  haemodynamic response to laryngoscopy and intubation. Indian 2002; 46: 124-9.

22.  Deepshikha C TripathiKomal S ShahSantosh R DubeyShilpa M Doshi, and Punit V  Raval Hemodynamic stress response during laparoscopic cholecystectomy: Effect of  different doses of intravenous clonidine premedication. J Anaesthesiol Clin Pharmacol. 2011 Oct-Dec; 27(4)475-480.

23.  Comparative study of intravenously administered clonidine and magnesium      sulfate on hemodynamic responses during laparoscopic cholecystectomyNand Kishore KalraAnil VermaApurva Agarwal, and HD Pandey J Anaesthesiol Clin Pharmacol. 2011 Jul-Sep; 27(3): 344–348

24.  Ghigone M, Calvillo O, Quintin L. Anesthesia and Hypertension: The effect  of  Clonidine  on  Perioperative  Hemodynamics  and  Isoflurane  Requirements .Anesthesiology 1987; 67; 3-10.

25.  Lee J, Lovell AT,  Parry MG, Glaiser HR, Bromley LM. I.V. clonidine does it work as a hypotensive agent with inhalation anaesthesia. British J  Anaesth 1999; 82(4): 639-40.

26.  Leslie K, Mooney PH, Silbert BS. Effect of Intravenous Clonidine on the Dose of Thiopental Required to Induce Anesthesia. Anesth Analg 1992;  75: 530-5.

27.  Ghafari  MH,  Akrami  M,  Nouralishahi  B,  Sadegh  A.  Preoperative  Clonidine and Gabapentin decreases postoperative pain and morphine  consumption after abdominal Jysterectomy. J Biol Sci 2009; 4: 458-63.

28.  Hidalgo MP, Auzani JA, Rumpel LC, Moreira NL, Cursino AW, Caumo  W. The clinical Effect of small Oral Clonidine Doses on Perioperative Outcomes in Patients Under going Abdominal Hysterectomy. Anaesth Analg 2005; 100: 795-802.  

29.  Bonnet F, Boico O, Rostaing S, Saada M, Loriferne JF, Touboul C, et al  Postoperative analgesia with extradural clonidine. Br J Anaesth 1989; 63:  465-9.

30.  Cigarini I, Kaba A, Bonnet F, Brohon E, Dutz F, Damas F, et al Epidural  clonidine combined with bupivacaine for analgesia in labor. Reg Anesth  1995; 20: 113-20.

31.  Rostaing S, Bonnet F, Levron J, Vodinh J, Pluskwa F, Saada M. Effect of  epidural clonidine on analgesia and pharmacokinetics of epidural fentanyl  in postoperative patients. Anesthesiology 1991; 75: 420-5.

32.  Ghodki PS, Sardesai SP, Thombre SK.  Evaluation of the effect of  intrathecal clonidine to decrease shoulder tip pain in laparoscopy under  spinal anaesthesia. Indian J Anaesth 2010; 54(3): 231-4.

33.  Eisenach JC, Rauck RL, Buzzanell C, Lysak SZ. Epidural clonidine  analgesia for intractable cancer pain: phase, 1. Anesthesiology 1989; 71:647-52.

34.  Leonard IE, Cunningham AJ. Anaesthetic considerations for laparoscopic  cholecystectomy. Best Pract Res Clin Anaesthesiol 2002; 16(1): 1-20.

35.  Batra RK, Garg R. Anaesthesia for Laparoscopic and other Endoscopic  Surgery. J Postgraduate Med Edu Training Res 2008; III(3):

36.  Joris J. Anaesthesia for Laparoscopic Surgery in Millers Anaesthesia. 7th  ed.,   San   Francisco,   California:   Churchill   Livingstone   Elsevier  publications; 2010.

37.  Hirvonen  EA,  Poikolainen  EO,  Pääkkönen  ME,  Nuutinen  LS.  The  adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy. Surg  Endosc 2000; 14(3): 272-7.

38.  Wahba  RW,  Béïque  F,  Kleiman  SJ.  Cardiopulmonary  function  and  laparoscopic cholecystectomy. Can J Anaesth 1995; 42(1):51-63.

39.  Kamolpornwijit W, lamtrirat P, Phupong V. Cardiac and Hemodynamic Changes during Carbon dioxide Pneumoperitoneum for Laparoscopic Gynecologic Surgery. J Med Assoc Thai 2008; 91[5]: 603-7.

40.  40. Howe   JR,   Wan   J-Y,   Yaksh   TL.   Selective   antagonism   of   the  antinociceptive effect

of intrathecally applied alpha adrenergic agonists by  intrathecal prazosin and intrathecal yohimbine. Journal of Pharmacology  and Experimental Therapeutics 1983; 224: 552-8.

41.  Persec J, Persec Z, Husedzinovic I. Postoperative pain and systemic  inflammatory stress response after preoperative analgesia with clonidine  or levobupivacaine. Eur J Med 2009; 121: 558-63.

42.  Schneemilch  CE,  Bachmann  H,  Ulrich  A,  Elwert  R,  Halloul  Z, Hachenberg   T.   Clonidine   Decreases   Stress   Response   in   Patients  Undergoing  Carotid  Endarterectomy  Under  Regional  Anesthesia:  A  Prospective,  Randomized,  Double-Blinded,  Placebo-Controlled  Study.  Anesth Analg 2006; 103: 297-302.

43.  De Noyer M, Laveleye F, Vauquelin G, Gobert J, Wülfert E. Mivazerol, a  novel compound with high binding specificity for alpha α2 adrenergic receptors:  binding  studies  on  different  human  and  rat  membrane preparations. Neurochemistry International 1994; 24: 221-9.

44.  Bernard JM, Hommeril J, Passuti N, Pinaud M. Postoperative Analgesia  by IV Clonidine, Anaesthesiology 1991; 75: 577-582

45.  Maze M, Tranquilli W. Alpha 2 Adrenoceptor Agonists: Defining role in  Clinical Anaesthesia. Anaesthesiology 1991; 74: 581-605.

46.  Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor  agonists-Their pharmacology and therapeutic role. Anaesthesia. 1999;  54: 146-65.

47.  .Laisalmi M, Koivusalo AM, Valta P, Tikkanen I, Lindgren L. Clonidine  provides opioid-sparing effect, stable hemodynamics, and renal integrity  during laparoscopic cholecystectomy. Surg Endosc (2001) 15: 1331-6.

48.  Joris JL, Chiche JD, Canivet JL, Jacquet NJ, Legros JJY, Lamy ML.  Haemodynamic   changes   Induced   by   laparoscopy   and   endocrine  correlates:   Effects   of   clonidine   Journal   of   American   College   of  Cardiology 1998; 32: 1389-96.

49.  Ruffolo RR. Distribution and function of peripheral α-adrenoceptors on  the cardiovascular system. Pharmacology, Biochemistry and Behavior 1985; 22: 827-33.

50.  Nichols AJ. Alpha-adrenoceptor signal transduction mechanisms, alpha- adrenoceptors. In: Ruffolo RR Jr, ed. Molecular Biology, Biochemistry  and Pharmacology. New York: Karger; 1991: 44-74.

51.  Tibirica E, Feldman J, Mermet C, Gonon F, Bousquet P. An imidazoline  specific mechanism for the hypotensive effect of clonidine. A study with  yohimbine and idazoxan. J Pharmacol Exp Therapeutics 1991; 256: 606-13.

52.  Zochowski  RJ,  Lada  W.  Intravenous  clonidine  in  acute myocardial  infarction in men. International J Cardiol 1984; 6: 189-201.

53.  Bailey PL,S Perry RJ,Johnson GK et al Respiratory effects of clonidine alone and combined with morphine in humans, Anaesthesiology 1991;74:43-8.

54.  Watkins J, Gerald FG, Zamboulis C, Brown MJ, DolleryCT. Absence of opiate and histamine H2 receptor-mediated effects of clonidine. Clin Pharmacol Therapeutics 1980; 28: 605-10.

55.  Litwin DE, Cahan MA. Laparoscopic cholecystectomy.Surg Clin North Am 2008; 88(6): 1295-313.

56.  Calland JF, Tanaka K, Foley E, Bovbjerg VE, Markey DW, Blome S, et al.  Outpatient  laparoscopic  cholecystectomy:  patient  outcomes  after implementation of a clinical pathway. Ann Surg 2001; 233(5): 704-15.

57.  Shea JA, Berlin JA, Bachwich DR, Staroscik RN, Malet PF, McGuckin M. Indications for and outcomes of cholecystectomy: a comparison of the pre and  postlaparoscopic eras. Ann Surg 1998; 227(3):343-50.                     

58.  Tameatsu Murai DDS, Naoto Kyoda, DDS, PhD, Toru Misaki, DDS, PhD,Koji  Takada, DDS, PhD, Sakae Sawada, DDS, and Toru Machida, DDS Effects of  Clonidine on Intravenous Sedationwith midazolam Anesth Prog 42:135-138 1995

59.  Velayadha Siddha Reddy ,Nawaz Ahmad SK,Balaji Donthu,Venkatsiva Jangam.Intravenous dexmedetomidineversus clonidine for prolongation of bupivaccaine spinal anaesthesia and analgesia:A randomized double blind study.Journal of Anaesthesiology clinical pharmacology/Jul- Sep2013/vvol29/issue-3.

60.  J.E.Hall,J.D.Uhrich & J.J.Ebert,Sedative,analgesic &cognitive effects of clonidine in fusion in humans.Br.J.Anaesthesia 2001,86:5-11.

61.  Hayashi Y,maze M.Alpha @ -adrenoreceptor agonists and anesthesia.Br .J.Anaesthesia 1993;71:108-18.

62.  Manjushree Ray,Dhurjoti Prosad Bhattacharjee,Bimal Hajra,Rita Pal,Nilay Chatterjee.Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamic and postoperative recovery:Acomparative study.Indian Journal of anaesthesia?vol.54/issue 2/Mar-Apr 2010.

63.  C.GuranA,Mois,E.Dragulin,N.Mincu,G,stelea.The influence of the alpha-2 agonost clonidine on perioperative haemodynamic stability,sedation.anxiety and analgesia in medium amplitude abdominal surgery. European Journal of Anaesthesiology.June 2007, voi 24 issue –p181.

Corresponding Author

Dr Rushikesh C Desai

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: 9405914167