Study on Role of Oral Clonidine in Laparoscopic Cholecystectomy Surgery – A Comparative Study

Abstract

Laparoscopic surgical techniques have been rapidly accepted by the surgeon worldwide e.g. especially laparoscopic cholecystectomy, with published reports describing the benefits of less postoperative pain, reduced hospital stay and an earlier return to work. The hall mark of laparoscopic surgery is the creation of pneumoperitoneum with pressurized CO₂. The high solubility of CO₂ increases systemic absorption by the vasculature of the peritoneum. This, combined with smaller tidal volumes because of poor lung complication, leads to increased arterial CO₂ levels which is known as hypercarbia. If hypercarbia allowed to develop, will stimulate the sympathetic nervous system and thus increase heart rate, blood pressure, and the risk of dysrhythmias. These effects can prove especially challenging in patients with restrictive lung disease, impaired cardiac function, or intravascular volume depletion . The present study was to evaluate the role of oral clonidine and atenolol in controlling tachycardia and hypertension associated with pneumoperitoneum with CO2 during laparoscopic cholecystectomy under general anaesthesia and also to find out the best premedicant in controlling heamodynamic instability in laparo-scopic cholecystomy. 75 patients schedule for laparoscopic cholecystectomy were randomly selected by blind envelop method. Patients were divided equally into three groups, which were Group-I: Oral clonidine(150ìgm), Group-II: oral atenolol(25mg) and Group-III: placebo (vitamin-c tablet), twenty five patients were in each group

The mean difference of pulse rate at different times was significant (p<0.05), however just before induction, just after skin incision and just after insufflations CO₂ were not significant (p>0.05). The mean differences of systolic, diastolic BP at different times were not significant (p>0.05), however BP was almost stable just before induction to the end of the operation in group I patients. The mean difference of SPO₂ at different times was not significant(p>0.05) but just after intubations (99.6%±0.5% in group I, 99.3% ±0.5% in group II and 98.7%±1.1% in group III) and just after skin incision (99.5%±0.6% in group I, 98.9%± 0.6% in group II and 98.3% ±0.9 % in group III) was significant (p<0.05). The mean difference of ETCO₂ at different times was not significant (p>0.05) however after 5 minutes insufflations (35.8±0.8 mmHg in group I, 36.5±0.5 mmHg in group II and 35.5±0.8 mmHg in group III) was significant (p<0.05). The mean (±SD) halothane intake of group I patients was 0.49±0.06%, 0.56±0.10% in group II and 0.66±0.09% in group III. The mean (±SD) duration of first analegesic demand of the patents was 90.8±8.5 minutes in group I, 74.0±8.5 minutes in group II and 72.2±8.7 minutes in group III. The mean difference of halothane requirement & duration of first analegesic demand were significant (p<0.05). The aldrete recovery status of original criteria were almost similar in three groups (p>0.05).

We can conclude that oral clonidine and atenolol to control heart rate & haemodynamic instability in laparoscopic cholecystectomy under general anaesthesia is better than placebo.  

Journal of BSA, Vol. 21, No. 1, January 2008 12-20