Title: Hemodynamic Stress Response during Laparoscopic Cholecystectomy: Effect of Oral Administration of Moxonidine

Authors: Avijit Kumar Prusty, Jagannath Mishra

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i6.96

Abstract

Background: In the event of laparoscopic surgeries, pneumoperitoneum can prelude to wide array of pathophysiologic changes in the cardiovascular system which may overture to hypertension and tachycardia. Thus, search for an ideal pharmacological agent to prevent the hemodynamic response is vital.

Objective: Thus, the present study was undertaken to evaluate the effect of orally administered moxonidine in attenuating the hemodynamic responses that occur during the laparoscopic surgeries.

Patients and Methods: A total of 50 adult ASA I and II patients scheduled for elective laparoscopic surgeries were selected for the study. The patients were divided into two groups moxonidine group (M) and placebo group (P). M group received oral moxonidine 0.3 mg at 8 pm on the day before surgery and at 8 am on the day of surgery. P group received a placebo at the same timing as that of the M group.

Results: Following pneumoperitoneum rise in systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and heart rate (HR) was higher in P group in comparison to M group which was statistically significant.

Conclusion: Significant rise in HR, SBP, DBP, and mean BP was noted in the P group in comparison to moxonidine group. Moxonidine provided better preoperative hemodynamic stability in patients undergoing laparoscopic surgeries.

Keywords: Laparoscopic surgery, moxonidine, pneumoperitoneum, hemodynamic changes.

References

1.      Cunningham AJ, Brull SJ. Laparoscopic Cholecystectomy: Anesthetic implications. Anaesth Analg. 1993; 76:1120–33

2.      Jean LJ. Anaesthesia for Laparoscopic surgery. In: Miller RD, editor. Anesthesia. 7th ed. New York: Churchill Livingstone; 2010. pp. 2185–202.

3.      Thune A, Appalgren L, Haglind E. Prevention of post operative nausea and vomiting after laparoscopic cholecyst-ectomy. Eur J Surg. 1995; 161:265–8.

4.      Feig BW, Berger DH, Doughtery TB, Dupuis JF, His B, Hickey RC, et al. Pharmacologic intervention can reestablish baseline hemodynamic parameters during laparoscopy. Surgery. 1994; 116:733–9.

5.      Aho M, Scheinin M, Lehtinen AM, Erkola O, Vuorinen J, Korttila K. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg. 1992; 75:932-9.

6.      Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine respo-nses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987; 59:295-9.

7.      Saif GM, Singh V, Kumar A, Wahal R, Bhatia VK. A study of cardiovascular response during laryngoscopy and intubation and their attenuation by ultra-short acting beta-blocker esmolol. Indian J Anaesth 2002; 46:104-6.

8.      Farsang C. Moxonidine: Clinical profile. J Clin Basic Cardiol 2001;4:197-200.

9.      Joris JL, Chiche JD, Canivet JL, Jacquet NJ, Legros JJ, Lamy ML. Hemodynamic changes induced by laparoscopy and their endocrine correlates: Effects of clonidine. J Am Coll Cardiol 1998;32:1389-96.

10.  Koivusalo AM, Scheinin M, Tikkanen I, Yli-Suomu T, Ristkari S, Laakso J, et al. Effects of esmolol on hemodynamic responses to CO2 pneumoperitoneum for laparoscopic surgery. Acta Anaesthesiol Scand 2008; 42:510-7.

11.  Fenton C, Keating GM, Lyseng-Williamson KA. Moxonidine: A review of its use in essential hypertension. Drugs 2006;66:477-96.

12.  Malek J, Knor J, Kurzova A, Lopourova M. Adverse hemodynamic changes during laparoscopic cholecystectomy and their possible suppression with clonidine premedication. Comparison with intrav-enous and intramuscular premedication. Rozhl Chir 1999; 78:286-91.

13.  Sung CS, Lin SH, Chan KH, Chang WK, Chow LH, Lee TY. Effect of oral clonidine premedication on perioperative hemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Sin 2000;38:23-9.

14.  Das M, Ray M, Mukherjee G. Hemody-namic changes during laparoscopic cholecystectomy: Effect of oral clonidine premedication. Indian J Anaesth 2007; 51:205-10.

15.  Bansal T, Hooda S. Newer drugs in anaesthesia. Int J Pharm Pharm Sci 2012; 4:668-70.

16.  Banday M, Sameer A. Gabapentine: A pharmacotherapeutic Panacea. Int J Pharm Pharm Sci 2013;5:84-94.

Corresponding Author

Dr. Avijit Kumar Prusty

Senior Resident, Department of Anaesthesiology, Maharajah's Institute of Medical Sciences,

Vizianagaram, Andhra Pradesh

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