Prospective Comparative Study of Clonidine, Magnesium Sulphate and Dexmedetomidine on Hemodynamic Changes During Laparoscopic Surgeries

Abstract

Background: Hemodynamic changes following pneumoperitoneum are common during laparoscopic surgeries. Various measures and drugs have been tried but none has proved ideal.

Aim: To evaluate the attenuation of hemodynamic changes during laparoscopic surgeries using intravenous clonidine, magnesium sulphate and dexmedetomidine in adult patients.

Methods: A randomised prospective study was conducted over 10 months after Institutional Ethical Committee clearance. Ninety-two patients were randomly allocated into four groups of 23 each including a control group: Group I (clonidine 1 µg/kg), Group II (magnesium sulphate 30 mg/kg), Group III (dexmedetomidine 1 µg/kg) and Group IV (normal saline). Heart Rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and rate pressure product (RPP) were compared before induction, after induction, before and after intubation, before pneumoperitoneum (BP) and 5 min (P5), 10 min (P10),15 min (P15), 30 min (P30) & 45 min (P45) after pneumoperitoneum.

Result: A significant fall in HR, SBP, DBP, MAP and RPP was seen with time in all the groups (p<0.001 for all). Dexmedetomidine significantly attenuated HR compared with control at 5, 10 and 15 minutes after pneumoperitoneum creation. A significant time×group interaction was seen with SBP (p<0.001, partial η²=0.101), DBP (p=0.002, partial η²=0.085) and MAP (p<0.001, partial η²=0.122), but not for RPP (p=0.16). Bonferroni-adjusted comparisons showed dexmedetomidine had significantly lower HR than clonidine at 5 minutes and lower HR than control at 5, 10 and 15 minutes; lower SBP than control at 10 and 15 minutes; and lower MAP than control at 10 and 15 minutes. Clonidine had significantly lower SBP than control at 15 minutes and lower MAP than control at 15 minutes. Magnesium sulphate did not differ significantly from control at any time point, but had significantly higher SBP than dexmedetomidine at 15 minutes and higher MAP than dexmedetomidine at 10 and 15 minutes. RPP showed no significant time×group interaction or overall between-group difference.

Conclusion: Dexmedetomidine produced the most consistent attenuation of HR, SBP and MAP at specific early time points after pneumoperitoneum creation. Clonidine showed isolated attenuation of SBP and MAP, whereas magnesium sulphate did not differ significantly from control in adjusted comparisons. RPP changed significantly with time but showed neither a significant time×group interaction nor an overall between-group difference.