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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Autores principales: anish kumar singh, Sanjay Johar, Sudesh kumar, mamta jain, Kiranpreet Kaur, Jatin Lal, Preeti Gehlaut
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Publicado: JCDR Research and Publications Private Limited 2021
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spelling oai:doaj.org-article:6a085b680db04bb6a08f04a5e315d9492021-11-12T17:35:08ZEffect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy - A Randomised Controlled Trial10.7860/JCDR/2021/49934.154432249-782X0973-709Xhttps://doaj.org/article/6a085b680db04bb6a08f04a5e315d9492021-09-01T00:00:00Zhttps://www.jcdr.net/articles/PDF/15443/49934_CE[Ra1]_F[SH]_PF1(AKA_SHU)_PFA(AKA_AnK_KM)_PN(KM).pdfhttps://doaj.org/toc/2249-782Xhttps://doaj.org/toc/0973-709XIntroduction: 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.anish kumar singhSanjay Johar Sudesh kumarmamta jainKiranpreet KaurJatin LalPreeti GehlautJCDR Research and Publications Private Limitedarticleadrenergic α-2 receptor agonistshypertensionintubationpneumoperitoneumMedicineRENJournal of Clinical and Diagnostic Research, Vol 15, Iss 9, Pp UC29-UC33 (2021)
institution DOAJ
collection DOAJ
language EN
topic adrenergic α-2 receptor agonists
hypertension
intubation
pneumoperitoneum
Medicine
R
spellingShingle adrenergic α-2 receptor agonists
hypertension
intubation
pneumoperitoneum
Medicine
R
anish kumar singh
Sanjay Johar
Sudesh kumar
mamta jain
Kiranpreet Kaur
Jatin Lal
Preeti Gehlaut
Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy - A Randomised Controlled Trial
description 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.
format article
author anish kumar singh
Sanjay Johar
Sudesh kumar
mamta jain
Kiranpreet Kaur
Jatin Lal
Preeti Gehlaut
author_facet anish kumar singh
Sanjay Johar
Sudesh kumar
mamta jain
Kiranpreet Kaur
Jatin Lal
Preeti Gehlaut
author_sort anish kumar singh
title Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy - A Randomised Controlled Trial
title_short Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy - A Randomised Controlled Trial
title_full Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy - A Randomised Controlled Trial
title_fullStr Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy - A Randomised Controlled Trial
title_full_unstemmed Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy - A Randomised Controlled Trial
title_sort effect of dexmedetomidine on perioperative haemodynamic fluctuations in untreated stage 1 hypertensive patients undergoing laparoscopic cholecystectomy - a randomised controlled trial
publisher JCDR Research and Publications Private Limited
publishDate 2021
url https://doaj.org/article/6a085b680db04bb6a08f04a5e315d949
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