Estimation of Blood Glucose Levels And Hemodynamic Changes During Laparoscopic Cholecystectomy: A Comparison of Dexmedetomidine and Nalbuphine

Abstract

Objective: To compare the effect of Dexmedetomidine and Nalbuphine premedication on changes in hemodynamics and neuroendocrine stress response under general anaesthesia by analyzing the variation of perioperative serial blood glucose levels.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Services Hospital, Lahore Pakistan, from Oct to Dec 2020.
 Methodology: Total 90 patients aged between 30-and 65 years were allocated randomly into three groups. Group-D patients (n=30) were administered Dexmedetomidine 0.5 μg/kg in 100 ml normal saline, group-N (n=30) were given Nalbuphine 0.1 mg/kg in 100ml saline, and group-S received saline (100ml) throughout 15 minutes before induction of anaesthesia for laparoscopic cholecystectomy. General Anaesthesia was administered. Intra-abdominal pressure was maintained after abdominal insufflation with carbon dioxide between 12-15 mmHg. Blood glucose levels were analyzed preoperatively, 30 minutes after the beginning of surgery, at extubation and 2.5 hours postoperatively. Hemodynamic changes were recorded after premedication, 15 and 30 minutes after pneumoperitoneum and extubation.
 Results: Random mean blood sugar levels were 135.23 mg/dl with Dexmedetomidine and 123.33 mg/dl with Nalbuphine and 122.53 mg/dl in saline group (p<0.05). There was a greater decrease in hemodynamic parameters with group-D than with groups N and S (p<0.01).
 Conclusion: During laparoscopic cholecystectomy, intravenous Dexmedetomidine premedication attenuates the hemodynamic stress response better than Nalbuphine but does not suppress the neuroendocrine response as estimated by a rise in random blood glucose level.

Effect of dexmedetomidine on perioperative haemodynamics and early cognitive function in elderly patients undergoing laparoscopic surgery.

“…Our findings revealed that at T3 and T4 the dexmedetomidine group displayed a significantly lower level of renin activity and norepinephrine than the control group, indicating that the use of the drug is advantageous for maintaining stable hormone levels during extubation. Key findings in the study of Asad included the same demonstration [ 24 ]. MMSE, VAS, and Ramsay scores were evaluated after operation, and the results showed that VAS scores in dexmedetomidine group were obviously lower than those in the control group, while MMSE and the Ramsay score in the dexmedetomidine group were apparently higher than that in control group at 12 h after operation.…”

“…One day before surgery, there were no significant differences in Mini-mental state examination (MMSE), visual analogue scale (VAS), and Ramsay scores between the 2 groups (p > 0.05), but the MMSE score 1 day after surgery and the Ramsay score at 12 h after surgery in the dexmedetomidine group were much higher than that in the control group (p < 0.05). Notably,at 2,4,12,24, and 48 h after surgery, the VAS score in the dexmedetomidine group was significantly lower than that in the control group (p < 0.05). Conclusions: Dexmedetomidine has a better clinical effect in improving perioperative haemodynamics and early cognitive function in elderly gynaecological patients who received laparoscopic surgery.…”