Effects of dexmedetomidine on perioperative monitoring parameters and recovery in patients undergoing laparoscopic cholecystectomy in a 300 bedded hospital, Jaipur

Mohit  Kumar; Varun Kumar Saini; Kumar  Asnani; Vivek Singhal; Rajesh  Bhargava; Shaveta Kataria

doi:10.18231/j.joapr.2022.10.3.18.27

Authors

Mohit Kumar Department of Anesthesiology, RUHS-CMS, Jaipur, 302033, Rajasthan
Varun Kumar Saini Department of Anesthesiology, RUHS-CMS, Jaipur, 302033, Rajasthan
Kumar Asnani Department of Anesthesiology, RUHS-CMS, Jaipur, 302033, Rajasthan
Vivek Singhal Dept. of Anaesthesiology and critical Care, Govt RDBP Jaipuria Hospital RUHS-CMS, Jaipur
Rajesh Bhargava Dept. of Anaesthesiology and critical Care, Govt RDBP Jaipuria Hospital RUHS-CMS, Jaipur
Shaveta Kataria Department of Microbiology, Mahatma Gandhi University of Medical Science & Technology, Jaipur https://orcid.org/0000-0003-3406-5534

DOI:

https://doi.org/10.18231/j.joapr.2022.10.3.18.27

Keywords:

ASA grading, dexmedetomidine, Laparoscopic Cholecystectomy, Perioperative

Abstract

Background: Laparoscopic cholecystectomy has emerged over the open cholecystectomy as gold standard for surgical treatment of symptomatic gall stones. Although pain after laparoscopic cholecystectomy is less intense, but many patients may experience considerable pain during first 24 hours in post-operative period. Intravenous (i.v.) use of dexmedetomidine in perioperative period lead to 90% decrease in the serum catecholamine levels, and further diminishing the haemodynamic response and sedating the patient and decrease analgesic requirements in the post-operative period. The efficacy of dexmedetomidine in providing hemodynamic stability during perioperative period and anesthesial recovery in patients undergoing laparoscopic cholecystectomy is studied. Methods: 60 patients of ASA grade I and II and of either sex (20–50 years) allocated in one of two parallel groups containing 30 patients each. In Group A- Dexmedetomidine (i.v.) bolus over 10min and continuous maintenance infusion 0.5µg/kg/h and in group B-0.9% normal saline i.v. bolus and continuous maintenance infusion was done. Parameters noted were heart rate, mean arterial pressure, oxygen saturation, post-operative pain were evaluated using VAS and analgesic requirement. Results: Both the groups were similar results in terms of age, sex, weight, ASA status, duration of surgery and hemodynamic parameters. SBP, DBP, MAP, SpCO₂, EtCO₂ values for both the groups were similar at all the intervals of time. No significant side effects were noted. Conclusion: Dexmedetomidine, pre-anaesthetic medication and its intraoperative infusion, further reducing the intraoperative anaesthetic requirement, sympathoadrenal response to intubation, maintains intraoperative cardiovascular stability, smooth extubation, sedation, and reduction in postoperative complications.

Downloads

Download data is not yet available.

References

Traverso LW. Carl Langenbuch and the first cholecystectomy. American Journal of Surgery, 132(1), 81-82 (1976)

Glenn F. Trends in surgical treatment of calculus disease of biliary tract. Surgery Gynecology Obstetrics, 140(6), 877-884 (1975)

Dubois F, Icard P, Berthelot G, Levard H. Coelioscopic cholecystectomy- preliminary report of 36 cases. Annals of Surgery, 211(1), 60–62 (1990)

Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy: the new gold standard. The Archives of Surgery, 127(8), 917-921 (1992)

Yegiyants S, Collins JC. Operative strategy can reduce the incidence of major bile duct injury in laparoscopic cholecystectomy. American Surgery, 74(10), 985-987 (2008)

Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Annals of Surgery, 234(1), 549-558 (2001)

Joris J, Cigarini I, Legrand M, Jacquet N, De-Groote D, Franchimont P, Lamy M. Metabolic and respiratory changes after cholecystectomy performed via laprotomy or laparoscopy. British Journal of Anaesthesia, 69(4), 341–345 (1992)

Lim SH, Jang EH, Kim MH, Cho K, Lee JH, Lee KM, Cheong SH, Kim YC, Shin CM. Analgesic effect of preoperative versus intraoperative dexamethasone after laparoscopic cholecystectomy with multimodal analgesia. Korean Journal of Anesthesiology, 61(4), 315–319 (2011)

Larsen JF, Svendsen FM, Pedersen V. Randomized clinical trial of the effect of pneumoperitoneum on cardiac function and haemodynamics during laparoscopic cholecystectomy. British Journal of Surgery, 91(7), 848–854 (2004)

Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML. Hemodynamic changes during laparoscopic cholecystectomy. Anesthesia and Analgesia, 76(5), 1067–1071 (1993)

Mansour EE. BIS-guided evaluation of dexmedetomidine vs midazolam as anaesthetic adjuncts in off-pump coronary artery bypass surgery (OPCAB). Saudi Journal of Anaesthesia, 3(1), 7–14 (2009)

Wallukat G. The beta-adrenergic receptors. Herz, 27(7), 683-690 (2002)

Ghodki PS, Thombre SK, Sardesai SP, Harnagle KD. Dexmedetomidine as an anesthetic adjuvant in laparoscopic surgery: an observational study using entropy monitoring. Journal of Anaesthesiology Clinical Pharmacology, 28(3), 334–338 (2012)

Manne GR, Upadhyay MR, Swadia V. Effects of low dose dexmedetomidine infusion on haemodynamic stress response, sedation and post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy. Indian Journal of Anaesthesiology, 58(6), 726–731 (2014)

Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic and analgesic properties of small-dose dexmedetomidine infusions. Anesthesia and Analgesia, 90(3), 699–705 (2000)

Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans II-hemodynamic changes. Anaesthesiology, 77(6), 1134–1142 (1992)

Isik B, Arslan M, Ozsoylar O, Akcabay M. The effects of α2-adrenergic receptor agonist dexmedetomidine on hemodynamic response in direct laryngoscopy. Open Otorhinolaryngology Journal, 1, 5–11 (2007)

Mann C, Boccara G, Pouzeratte Y, Eliet J, Serradel GC, Vergnes C, Bichet DG, Fabre JM, Colson P. The relationship among carbon dioxide pneumoperitoneum, vasopressin release and hemodynamic changes. Anesthesia and Analgesia, 89(2), 278–283 (1999)

Chilkoti GT, Karthik G, Rautela R. Evaluation of postoperative analgesic efficacy and perioperative hemodynamic changes with low dose intravenous dexmedetomidine infusion in patients undergoing laparoscopic cholecystectomy – arandomised, double-blinded, placebo-controlled trial. Journal of Anaesthesiology Clinical Pharmacology, 36(1), 72–77 (2020)

Ye Q, Wang F, Xu H, Wu L, Gao X. Effects of dexmedetomidine on intraoperative hemodynamics, recovery profile and postoperative pain in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. BMC Anesthesiology, 21, 63-80 (2021)

Khare A, Sharma SP , Deganwa ML, Sharma M, Gill N. Effects of Dexmedetomidine on intraoperative hemodynamics and propofol requirement in patients undergoing Laparoscopic Cholecystectomy. Anesthesia Essays and Research, 11(4), 1040-1045 (2017)

Chavan SG, Shinde GP, Adivarekar SP, Gujar SH, Mandhyan S. Effects of dexmedetomidine on perioperative monitoring parameters and recovery in patients undergoing laparoscopic cholecystectomy. Anesthesia Essays and Research, 10(2), 278-283 (2016)

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian Journal of Anaesthesiology, 55(4), 352-357 (2011)

Sebastian B, Talikoti AT, Krishnamurthy D. Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomidine: a comparison between two doses. Indian Journal of Anaesthesiology, 61(1), 48–54 (2017)

Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Col P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clinical Pharmacokinetics, 56(8), 893–913 (2017)

Bhattacharjee DP, Nayek SK, Dawn S, Bandopadhyay G, Gupta K. Effects of dexmedetomidine on haemodynamics in patients undergoing laparoscopic cholecystectomy – a comparative study. Journal of Anaesthesiology Clinical Pharmacology, 26(1), 45 (2010)

Bakri MH, Ismail EA, Ibrahim A. Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Korean Journal of Anaesthesiology, 68(3), 254–260 (2015)