Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, Endotracheal intubation and Pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy, and to study the role of intravenous Clonidine Hydrochloride in attenuating hemodynamic response in these patients.Methods: 100 adult patients of either sex, with ASA physical status I and age 20 50 years were randomly allocated to receive Inj. clonidine hydrochloride 3?g/kg diluted in 10 ml Normal saline ( group 1) or 10 ml Normal saline as placebo ( group 2) fifteen minutes prior to induction of general anesthesia. Study parameters including heart rate, blood pressure (systolic, diastolic, mean arterial pressure) and rate pressure product were monitored and recorded at various intervals during the procedure.Results: Inter group comparison showed a highly significant rise (p<0.001) in heart rate in group 2 (placebo) during various interval compared to group 1 (clonidine group). Blood pressure (systolic, diastolic, mean arterial pressure) and rate pressure product followed a similar trend like heart rate in both groups and premedication with intravenous clonidine hydrochloride (3?g/kg) definitely attenuated the rise in these hemodynamic parameters during laryngoscopy, endotracheal intubation and pneumoperitoneum.Conclusions: Clonidine premedication, unless contraindicated, may be made as a routine practice to attenuate hyperdynamic response to laryngoscopy, endotracheal intubation and pneumoperitoneum, particularly in patients where such changes are undesirable (ASA III & IV).

Role Of Intravenous Clonidine Hydrochloride In Attenuating Hemodynamic Response To Laryngoscopy, Endotracheal Intubation And Pneumoperitoneum In Patients Undergoing Elective Laparoscopic Cholecystectomy

Background: Tracheal intubation is accompanied by varing degrees of sympathetic stimulation as reflected by increases in the heart rate and blood pressure. Several trials with pharmacologic agents have been conducted to reduce changes in blood pressure and heart rate. The aim of this study was to determine the appropriate dose of remifentanil required to prevent hemodynamic changes immediately after tracheal intubation in patients anesthetized with sevoflurane-N2O-O2. Methods: Ninety ASA class I or II patients scheduled for elective surgery were divided randomly into 6 groups: I, II, III, IV, V, and VI. After induction of anesthesia with thiopental, vecuronium, and sevoflurane 2 vol% with N2O/O2 50/50 via a face mask, saline, 0.3, 0.4, 0.5, 0.6, and 0.7μg/kg of remifentanil were given to group I, II, III, IV, V, and VI, respectively. Tracheal intubation was carried out for 90 seconds after drug administration, for patients in each group. The heart rate (HR), mean arterial pressure (MAP), and end tidal sevoflurane concentration (ETSEVO) were measured at preanesthesia, before intubation, and at 1 min after intubation, for each patient. Results: HR and MAP at 1 min after intubation were increased in groups I and II, and were unchanged in groups III, IV, V and decreased in group VI, as compared to preanesthetic values. Conclusions: A single injection of 0.4, 0.5, 0.6μg/kg of remifentanil was an appropriate dosage to prevent hemodynamic changes after tracheal intubation without adverse effects in patients anesthetized with sevoflurane-N2O-O2.

Sun Hee Kim

Papers

The Effect of Endotracheal Intabation and Extubation on the Blood Pressure and Heart Rate