Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy - A Randomised Controlled Trial
Introduction: Eighth Joint National Committee (JNC 8) has reclassified earlier prehypertension {Systolic Blood Pressure (SBP) 130-139 mm of Hg and/or Diastolic Blood Pressure (DBP) 80-89 mmHg} as stage 1 HTN. These patients may be at greater risk of perioperative haemodynamic instability, more s...
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
JCDR Research and Publications Private Limited
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/6a085b680db04bb6a08f04a5e315d949 |
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| Sumario: | Introduction: Eighth Joint National Committee (JNC 8) has
reclassified earlier prehypertension {Systolic Blood Pressure
(SBP) 130-139 mm of Hg and/or Diastolic Blood Pressure (DBP)
80-89 mmHg} as stage 1 HTN. These patients may be at greater
risk of perioperative haemodynamic instability, more so in case
of laparoscopic surgeries and alpha-2 agonists premedication
may be useful in such patients.
Aim: To assess perioperative haemodynamic fluctuations in
untreated stage 1 hypertension (HTN) patients and the role of
Dexmedetomidine (Dexmed) in it.
Materials and Methods: This prospective, randomised, double
blind study was conducted at Pandit Bhagwat Dayal Sharma
Postgraduate Institute of Medical Sciences, Rohtak, Haryana,
India from March 2019 to September 2020. Sixty-five patients
with stage 1 HTN not on any anti-hypertensive drugs undergoing
laparoscopic cholecystectomy were enrolled and randomly
divided into group D (dexmedetomidine) and group NS (Normal
Saline). Group D received Dexmed 1 µg/kg over 10 minutes before
induction, followed by continuous infusion of Dexmed at 0.2 µg/
kg/h and Group NS received similar volume of normal saline.
Serial recording of pulse rate, Mean Arterial Pressure (MAP) and
oxygen saturation was done. Postoperative sedation scores,
extubation time and time to first rescue analgesia were also
assessed. For analysis, quantitative variables were expressed
as mean±SD and compared using unpaired and paired t-test.
Mann-Whitney test was used for quantitative data that did not
follow a normal distribution. Qualitative variables were expressed
as frequencies/percentages and compared using Chi-square
test. A p-value <0.05 was considered statistically significant.
Results: A total of 60 patients (30 in group NS, mean age
38.40±10.32 years and 30 in group D, mean age 42.5±11.72
years) were analysed in the present study. In NS group,
haemodynamic variations were seen at induction, Laryngoscopy
and Intubation (L&I), creation and release of Pneumoperitoneum
(PNP) and extubation but actual changes were within 10-12%
of baseline value, whereas in group D, pulse rate and MAP
remained stable and moderately lower than baseline throughout
the perioperative period. An increase in extubation time was
observed in group D (15.57±3.16 vs.9.15±1.60 min). Group D also
had significantly higher sedation scores postextubation. Group
NS patients demanded rescue analgesia early (18.33±7.46 min
vs.43.53±8.57 min) (p=0.001).
Conclusion: It was concluded that the administration of i.v. Dexmed
1 µg/kg over 10 minutes followed by infusion at 0.2 µg/Kg/h results
in haemodynamic stability during surgical stress, slightly delayed
but smooth extubation, delayed demand of postoperative rescue
analgesia and mild sedation of short duration. Dexmed induced
effects help in improving the recovery profile of the patient and
keeping the patient more comfortable in the postoperative period. |
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