Effects of Intramuscular Dexmedetomidine as Premedication in Elective Laparoscopic Surgeries - A Prospective Randomized Controlled Study in Trichy, Tamilnadu

BACKGROUND The major concern of laparoscopic surgery is intra-operative hypercapnia induced stress response such as increase in heart rate (HR), increase in blood pressure (BP), increased stress hormones. The major concern of anaesthetist is to reduce stress response perioperatively. Drugs like clonidine, dexmedetomidine, nitroglycerine and esmolol are used to control the hemodynamic response associated with pneumoperitoneum in laparoscopic surgeries. Dexmedetomidine has been found to have hemodynamic stability with good analgesic effect. Dexmedetomidine is a highly selective α2 agonist with sedative, analgesic and sympatholytic properties. Here in this prospective randomized controlled study, we evaluate the effects of intramuscular dexmedetomidine as a premedication in laparoscopic cholecystectomy METHODS This is a randomized controlled study. Forty patients aged 20 to 50 years, both sexes, with American society of anaesthesiology (ASA) grade I & II planned for elective laparoscopic cholecystectomy were randomly assigned into two groups, Group DS : (N - 20) Received 2 mcg/kg of dexmedetomidine with normal saline (total 2 ml) Group CS : (N - 20) Received 2 ml of normal saline as intramuscular injection in the deltoid region 60 minutes before induction. We compared the hemodynamic parameters like pulse rate, mean arterial pressure (MAP) in baseline, preinduction, during intubation, before and after carbon dioxide insufflation, post extubation, visual analog score (VAS) and the analgesic requirements in both groups RESULTS Compared to control group, intramuscular dexmedetomidine group had statistically significant reduction in pulse rate, mean arterial pressure perioperatively during intubation, before and after carbon dioxide insufflation, during surgery and post extubation (P < 0.001) and also found to decrease the analgesic requirement post operatively CONCLUSIONS 2 mcg/kg intramuscular dexmedetomidine premedication produces better hemodynamic stability, reduced perioperative analgesic requirement and hence could be a better alternative to other premedicant agents.