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
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 (Co₂). 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
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