Effect of Dexmedetomidine Versus Fentanyl on Haemodynamic Response to Patients Undergoing Elective Laparoscopic Surgery: A Double Blinded Randomized Controlled Study

Abstract

Introduction: Dexmedetomidine, an a2 agonist, can be used as an adjuvant in general anaesthesia as it attenuates the stress response to various noxious stimuli and helps in maintaining the perioperative haemodynamic stability along with sedation and not causing any significant respiratory depression in the postoperative period. Aim: To study the difference in haemodynamic responses of dexmedetomidine and fentanyl in patients undergoing laparoscopic surgery. Materials and Methods: Sixty patients were divided into two groups of 30 each randomly. In Group F, fentanyl 0.5 μg/kg as loading dose over 10 minutes prior to induction followed by 0.2-0.7 μg/kg/hr as maintenance dose and in Group D, Dexmedetomidine 0.5 μg/kg as loading dose over 10 minutes prior to induction followed by 0.2 μg/kg/hr-0.7 μg/kg/hr as maintenance dose till surgery was over. Haemodynamic variables and Visual Analogue Scale (VAS) scores were recorded continuously. Postoperative sedation and recovery were assessed by modified Ramsay sedation score. Results: Systolic Blood Pressure (SBP) fell by 9% in Group-D as compared to no fall in Group F during intubation. After intubation, 9% increase is seen in Group D v/s 19% in Group F. During the period of pneumoperitoneum upto 5 minutes post extubation, the SBP in Group D was significantly lower as compared to Group F rest duration, the difference was not significant between both groups. Heart Rate (HR) remained stable throughout the study except at laryngoscopy when it rose. Heart rate was similar in both groups at intubation, decreased by 3.51% in Group D as compare to 11.11% rise in Group F. Post intubate on, heart rate fell by 2% in Group D vs 15% rise in Group F. Diastolic Blood Pressure (DBP) remained higher than baseline than throughout the study. After intubation, 3% higher in Group D where as 15% in Group F increase was seen. In intraoperative period the difference between both groups was not significant. There was significant difference between two groups at 10 minutes, 45 minutes of pneumoperitoneum. End Tidal CO2 (ETCO2 ) was similar in both groups. Conclusion: Dexmedetomidine is better drug as compared to fentanyl for maintaining the haemodynamic response during intubation and intraoperative period.

Keywords

• pneumoperitoneum
• ramsay sedation score
• stress response