Attenuation of Hemodynamic Response of Intubation and of Pneumoperitoneum during Laparoscopic Cholecystectomy: Comparison between Clonidine and Lignocaine

Background: Laparoscopic cholecystectomy is associated with hemodynamic stress responses both during endotracheal intubation and due to creation of pneumoperitoneum. This stress response is of great concern in hypertensive and geriatric population.Aim: Comparison between Clonidine and Lignocaine in terms of attenuation of hemodynamic response occurring due to Intubation and due to creation of Pneumoperitoneum during Laparoscopic Cholecystectomy.Subjects and Methods: This prospective, randomized, double blinded controlled study was conducted on eighty subjects of ASA Grade I and II undergoing elective laparoscopic cholecystectomy. Patients were allocated into two groups, Group C receiving clonidine and Group L receiving lignocaine. Baseline clinical parameters were recorded. All patients received clonidine or lignocaine as a bolus before induction as well as continuous intravenous infusion throughout the surgical procedure. The dose of clonidine given was 2.25 μg/kg bolus and 1.2 μg/kg/hr infusion while that of lignocaine was 1.5 mg/kg bolus and 0.8 mg/kg/hr infusion. The patients were mechanically ventilated to keep EtCO2 between 35 and 40 mm Hg. Heart rate, Systolic blood pressure and diastolic blood pressure were recorded before induction and at 1 min, 3 min, 10 min, 30 min, 60 min and 90 min after intubation. Any adverse effect like hypotension, bradycardia, sedation or shivering were noted and compared.Results: In comparison to Lignocaine group; attenuation of heart rate, Systolic blood pressure(SBP) and diastolic blood pressure (DBP) were significantly more in Clonidine group (p<0.05). There was no significant difference in sedation score between the two groups.Conclusion: Clonidine was found to be more effective than lignocaine in attenuating the hemodynamic response occurring both due to laryngoscopy and due to creation of pneumoperitoneum in laparoscopic cholecystectomy