A Prospective Randomised Study to Evaluate the Effects of Clonidine and Fentanyl as Premedication for Intraoperative Haemodynamic Stability in Patients Undergoing Laparoscopic Cholecystectomy.

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.

Transthoracic repair of diaphragmatic hiatus hernia with esophageal shortening where laparoscopic abdominal approach does not give satisfactory results.

A 50 year old female patient presented with history of regurgitation of food, heart burn, dyspepsia. Patient was investigated and presence of large hiatus hernia was confirmed on endoscopy, computed tomogram chest and barium swallow. Patient had severe symptoms even with maximum medical management, therefore surgical intervention was planned. Left posterolateral thoracotomy was done through sixth intercostal space. Mobilization of esophagus, reduction of stomach and Belsey Mark IV 270 degree anterolateral fundoplication was done. Patient was discharged on 7th postoperative day. First follow up was I month after the discharge and patient had significant relief from the preoperative problems.