Comparative evaluation of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy.

Srivastava, Vinit K; Nagle, Vaishali; Agrawal, Sanjay; Kumar, Diwakar; Verma, Amit; Kedia, Sunil

BACKGROUND The advent of laparoscopic surgery has benefited the patient and surgeon; however creation of pneumoperitoneum for same has bearings during the perioperative period. These effects of pneumoperitoneum are associated with significant haemodynamic changes, increasing the morbidity of the patient. AIM The present study compared the efficacy of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy Materials and Methods: A total of 90 patients aged 20-60 y, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for laparoscopic cholecystectomy were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine loading dose 1 mcg/kg over a period of 15 min and maintenance 0.5 mcg/kg/h throughout the pneumoperitoneum. Group E received esmolol loading dose 1 mg/kg over a period of 5 min and maintenance 0.5 mg/kg/h throughout the pneumoperitoneum. Group C received same volume of normal saline. MEASUREMENTS Heart rate (HR), systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP) were recorded preoperative, after study drug, after induction, after intubation, after pneumoperitoneum at 15 min intervals, post pneumoperitoneum and postoperative period after 15 min. Propofol induction dose, intraoperative fentanyl requirement and sedation score were also recorded. RESULTS In group D, there was no statistically significant increase in HR and blood pressure after pneumoperitoneum at any time intervals, whereas in Group E, there was a statistical significant increase in MAP after pneumoperitoneum at 15, 45, and 60 min only and HR during the whole pneumoperitoneum period. There was a significant decrease in induction dose of propofol and intraoperative fentanyl requirement in Group D and E, compared to Group C (p<0.0001). CONCLUSION Dexmedetomidine is more effective than esmolol for attenuating the hemodynamic response to pneumoperitoneum in elective laparoscopic cholecystectomy. Dexmedetomidine and esmolol also reduced requirements of anaesthetic agents.