Effects of Intravenous Dexmedetomidine and Clonidine on Haemodynamic Response in Laparoscopic Lower Abdominal Oncosurgeries under General Anaesthesia: A Randomised Controlled Trial

Abstract

Introduction: From the early 1970’s, laparoscopic procedures became well established because of their advantages like excellent visualisation, improved cosmesis, reduced postoperative pain and reduced hospital stay. Despite its advantages, laparoscopic surgeries have its demerits such as pneumoperitoneum and positional changes. Alpha-2 agonists have shown promising results in attenuating the stress response in laparoscopic surgeries. Aim: To compare clonidine and dexmedetomidine in attenuating haemodynamic stress response during laparoscopic lower abdominal oncosurgeries. Materials and Methods: A randomised controlled trial was conducted at Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India, during the period of December 2018 to May 2019. Institutional Ethical Committee clearance was obtained for the trial. Total 48 patients were recruited into two groups with 24 participants in each group: A (clonidine) and B (dexmedetomidine). Both drugs were infused at a dose of 1 μg/kg for 15 minutes along with premedication before induction. Haemodynamic stress response was estimated using parameters like Heart Rate (HR), systolic and diastolic blood pressure and mean arterial pressure at induction, pneumoperitoneum and at extubation. All the data were analysed using the statistical software R (V3.6.2). Continuous data were presented in the form of Mean±Standard Deviation (SD). The difference in mean value of the various parameters between the two groups was analysed using Student’s t-test. A p-value of <0.05 was considered to be significant. Results: Patients in both the groups were comparable with regards to demographic features. The mean age was 46.76±8.17 years, 46.24±9.70 years and weight was 55.76±7.28 and 56.08±6.06 for group A and group B, respectively. There were statistically significant differences in attenuating stress response in dexmedetomidine compared to clonidine group. Statistically significant reduction in the HR was noticed in group B as compared to group A at 12 minutes of infusion (p=0.008), at the end of infusion (p=0.008), before intubation (p=0.005), 10 minutes after intubation (p=0.008) and after pneumoperitoneum (p=0.045). Group B which was given dexmedetomidine drug compared to group A with clonidine drug showed better attenuation of the systolic blood pressure during extubation (p=0.006). Conclusion: To conclude, both clonidine and dexmedetomidine effectively attenuate the haemodynamic response in patients undergoing laparoscopic lower abdominal oncosurgeries when administered as intravenous bolus dose. In addition, the dexmedetomidine attenuates haemodynamic responses better than clonidine.

Comparison of efficacy between intravenous clonidine and dexmedetomidine as pre-medication in attenuating hemodynamic stress responses during laparoscopic cholecystectomy

“…Both drugs were found to attenuate the hemodynamic responses at induction, during pneumoperitoneum, and at extubation in patients undergoing laparoscopic lower abdominal oncosurgeries effectively. The attenuation of hemodynamic responses was better controlled with dexmedetomidine than clonidine 10. Other studies11,12 also report about better control of heart rate in patients receiving dexmedetomidine compared with clonidine during intubation and pneumoperitoneum.…”

“…The hemodynamic stability was found to be better with dexmedetomidine compared with clonidine. Hatti et al,10 compared clonidine and dexmedetomidine at a dose of 1 μg/kg for 15 min along with pre-medication before induction. Both drugs were found to attenuate the hemodynamic responses at induction, during pneumoperitoneum, and at extubation in patients undergoing laparoscopic lower abdominal oncosurgeries effectively.…”