Abstract :
Introduction: Advent of Laparoscopy have benefitted patients in terms of lesser tissue damage, early ambulation, decreased duration of hospital stay and reduced analgesic needs. However caproperitoneum and position of patient during laparoscopic procedure induces pathophysiological changes that may potentially complicate anesthetic management.
Various pharmacological methods have been tried to overcome complications associated with pneumoperitoneum. One among those drugs is Clonidine, a centrally acting a2-adrenergic receptors agonist has sedative, anxiolytic, analgesic properties and stabilizes circulatory system. It diminishes stress response hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries.
In addition, it increases cardiac bar reflex sensitivity in hypertensive individuals, and thus, stabilizes blood pressure by enhancing the role of changes in heart rate.
Objectives: To study the efficacy and post-operative sedation in intravenous and intrathecal clonidine in patients undergoing laparoscopic assisted vaginal hysterectomy under general anesthesia.
Materials and Methods: Patients were divided randomly into 2 groups (A group & B group) of 30 each. Patients assigned to group a, received 50 mcg of clonidine in 50ml of normal saline over 10 minutes 10 minutes before induction. Patients assigned to group B, received intrathecal clonidine 50 mcg in 1 ml in sitting position at L3-L4 interspace using 27G quincke’s spinal needle just before induction. Intraoperative monitoring included heart rate (HR), continuous electrocardiography, noninvasive systolic (SBP), diastolic (DBP), mean blood pressure (MBP), pulse oximetry (SpO2) and EtCO2. Systolic, diastolic, mean arterial blood pressures and heart rate were recorded at regular interval and plotted on graph.
Results: During capnoperitoneum, mean HR values, mean SBP values, mean DBP values, mean MAP values in (IT) group B were below the baseline and that in group A (IV) were near the baseline.
Conclusion: Efficacy of Intrathecal route of clonidine administration during laparoscopic hysterectomy surgeries have better control of heart rate, mean systolic and diastolic blood pressure and mean arterial pressure is better during capnoperitoneum compared to intra venous clonidine. But post-operative sedation and adverse effects in both routes are statistically insignificant.
Keyword :
Intrathecal clonidine, laparoscopic surgeries, Ramsay sedation score.