Blood glucose estimation as an indirect assessment of modulation of neuroendocrine stress response by dexmedetomidine versus fentanyl premedication during laparoscopic cholecystectomy: A clinical study

Abstract

Background:Anesthesia and surgery-induced neuroendocrine stress response can be modulated by appropriate premedication. The present study was designed to assess the clinical efficacy of dexmedetomidine versus fentanyl premedication for modulation of neuroendocrine stress response by analyzing the perioperative variation of blood glucose level during laparoscopic cholecystectomy under general anesthesia.Subjects and Methods:In a prospective randomized double-blind study, 60 adult consented patients of either sex with ASA I and II, scheduled for elective laparoscopic cholecystectomy under general anesthesia and meeting the inclusion criteria, were allocated into two groups. Group D patients (n = 30) were given intravenous dexmedetomidine 1μg/kg and Group F patients (n = 30) received fentanyl 2 μg/kg, given over a 10-min period, before induction of anesthesia. Perioperative blood glucose levels were analyzed preoperatively, at 30 min after beginning of surgery, and 2.5 h after surgery. Anesthetic and surgical techniques were standardized. All patients were also assessed for intraoperative hemodynamic changes of heart rate and mean arterial pressure at specific timings.Results:Blood glucose concentration has shown 20% increase after surgery. The differences between groups were not statistically significant as observed by analyzing the variation of serial perioperative blood glucose estimation. Both premedicants had attenuated the hemodynamic and neuroendocrine stress response of pneumoperitoneum and general anesthesia. The dexmedetomidine group showed more stabilization of intraoperative hemodynamics of mean arterial blood pressure and heart rate when compared to fentanyl group.Conclusion:During the laparoscopic cholecystectomy, dexmedetomidine and fentanyl, both premedicants have effectively modulated the neuroendocrine stress response of general anesthesia as assessed by analysis of perioperative blood glucose variation, but dexmedetomidine was better.

Serial Blood Glucose Level Estimation to Assess the Attenuation of Metabolic and Hemodynamic Stress Responses with Dexmedetomidine Infusion during Laparoscopic Surgery - A Randomized Control Study

“…[12] Blood glucose levels have been shown to correlate with catecholamine levels in surgical trauma patients. [13] The characteristic metabolic effect of surgical stress led to greater activation of neuroendocrine response and hepatic gluconeogenesis under perioperative conditions, which corresponds to hemodynamic changes and postoperative pain. There is strong correlation between hyperglycaemia and poor outcome.…”

Extra note of music in anaesthesia

“…Reduction in blood glucose has been seen in operative patients by some authors with use of music. 21,24…”

Post-operative insulin resistance

“…Использование эпидуральной (ЭДА) или реги-онарной анестезии связано с меньшим уровнем ИР при сравнении с вмешательствами под общей анесте-зией [51,52].…”

“…По литературным данным, снижение послеопераци-онной ИР возможно за счет: 1) использования эпидуральной анестезии/аналгезии на грудном уровне [50]; 2) применения мультимодальной аналгезии [52] [59]. Таким образом, выявление пациентов группы риска, коррекция дооперационной гипергликемии и приме-нение методов, снижающих риск развития ИР в после-операционном периоде, могут уменьшить уровень СГ и снизить вероятность обусловленных ею осложнений.…”