Effect of intravenous clonidine on hemodynamic changes in laparoscopic cholecystectomy: a randomized control study

Background: Laparoscopic surgery is associated with significant hemodynamic and pathophysiological changes due to creation of pneumoperitoneum. Clonidine is known to inhibit catecholamine and vasopressin release during pneumoperitoneum. This randomized, double-blinded, controlled study was conducted to evaluate the effect of administration of intravenous clonidine for the control of hemodynamic responses during the laparoscopic surgery and also to evaluate requirement of propofol during laparoscopic surgery. Methodology: 60 patients undergoing elective laparoscopic cholecystectomy were randomized into Group-C (clonidine group) and Group-S (saline group). In clonidine group patients received 3 mu g/kg of clonidine diluted in 10 ml saline over 10 minutes, while in saline group patients received 10 ml saline. Induction of anesthesia was same in both groups. Heart rate, systolic, diastolic blood pressure and mean arterial pressure were measured before premedication, before induction, after intubation, before CO2 insufflation, after insufflation and then subsequently at 15 min interval till desufflation and after extubation. Propofol requirement was calculated in both groups. Statistical Analysis: Unpaired 'T' test was used to compare both groups. Decision of applying unpaired t-test was based on normality test (Shapiro-Wilk). Results: Heart rate, systolic, diastolic and mean arterial blood pressures were significantly less in clonidine group as compared to control group. Intraoperatively there was significant heart rate variation in control group 82.93 +/- 6.53/min to 96.13 +/- 6.80/min than in clonidine group 86.30 +/- 9.12/min to 73.13 +/- 8.51/min (P<0.001). Mean blood pressure varied from 94.51 +/- 4.82 mmHg to 102.18 +/- 5.56 mmHg in control group while in clonidine group it varied from 94.14 +/- 7.82 mmHg to 72.62 +/- 1.87 mmHg. (P<0.001). Propofol requirement was significantly less in clonidine group. Conclusion: Administration of clonidine attenuates hemodynamic response to pneumoperitoneum and reduces the requirement of propofol.