ABSTRACT
Background: The cardiovascular implications due to CO2 insufflation during laparoscopic surgeries have been a subject of research. Animal studies have reported life threatening increase in serum potassium levels during rise in intra-abdominal pressure. Methods: Induction of 30 patients undergoing laproscopic cholecystectomy was done by giving Thiopentone sodium 5 mg/kg and orotracheal intubation was facilitated by 0.1 mg/kg of vecuronium bromide. Blood samples for potassium were taken at pre-induction, pre insufflation, every 20 minutes during insufflations, immediate post exsufflation and immediately after extubation. Results: Serum potassium increased significantly (p<0.01) after insufflation of carbon dioxide (pre-induction 3.9 ± 0.3 vs. 4.5 ± 0.3 at 40 minutes of insufflation). The haemodynamics i.e blood pressure and pulse rate remained fairly (p>0.05) throughout the study period. Conclusion: Based on the findings of this study, we recommend that monitoring of serum potassium should be done in patients undergoing laparoscopic procedures of prolonged duration.
ABSTRACT
Background: Laparoscopic surgeries are commonly done in patients suffering from cholelithiasis. However, laparoscopic surgeries are associated with pneumoperitoneum, increased intra-abdominal pressure and insufflation of carbon dioxide leading to altered haemodynamic stability. We conducted a prospective randomised study to evaluate the effects of Clonidine and fentanyl in premedication for intraoperative haemodynamic stability in patients undergoing laparoscopic cholecystectomy. Methods: 70 patients of either sex posted for elective laparoscopic cholecystectomy were included for our study. All patients were randomised using computer generated program and divided into two groups; Group F (35 patients): received Inj. Fentanyl (2 μg/kg IV) 5 minutes prior to induction of anaesthesia, whereas Group C (35 patients) received Inj. Clonidine (1 μg/kg IV) at the similar time before induction of anaesthesia. Haemodynamic parameters (heart rate, mean arterial pressure) of all patients were assessed prior to premedication, before induction, following laryngoscopy and intubation and after pneumoperitoneum. Results: The baseline mean heart rate and mean arterial pressure between Group C was found to be statistically insignificant on comparing with Group F. However, the mean heart rate after intubation, after creation of pneumoperitoneum and after extubation was observed to be statically significant between Group F and Group C (p=0.001). Similar statistical significance was observed between fentanyl group and Clonidine group after premedication and after intubation. Conclusion: Both Clonidine and fentanyl as a premedication had effectively attenuated intraoperative haemodynamic responses but the role of Clonidine was observed to be more appreciable.