A prospective randomized comparative clinical study to compare efficacy of Dexmedetomidine and Fentanyl to attenuate the pressor response to pneumoperitoneum during Laparascopic Surgeries

Abstract

Background: Laparoscopy has evolved over years from a invasive diagnostic tool to a cost effective therapeutic procedure .The induction of pneumoperitoneum triggers sympathetic stress responses and effective attenuation of pressor responses is essential to decrease surgery related perioperative morbidity and mortality. Aim of the study: To compare dexmedetomidine and fentanyl for attenuation of pressor response to pneumoperitoneum in patients undergoing elective laparoscopic surgeries. Materials and Methods: A prospective randomized comparative clinical study was conducted at Osmania General Hospital during 2017 -2020. Institutional Ethics Committee approved study protocol in which 60 patients of either gender in age group of 18 to 60yrs of ASA grade I , II physical status were included and divided into group D (Dexmedetomidine) (n-30) , group F (Fentanyl) ( n-30) to compare effect of dexmedetomidine and fentanyl on hemodynamic responses to pneumoperitoneum in patients scheduled for elective laparoscopic surgeries under general anaesthesia .Intraoperatively systolic and diastolic blood pressure , heart rate were recorded at predetermined time intervals and recored for statistical analysis. Results: Intraoperatively Systolic ,Diastolic blood pressure , Mean arterial pressure and Heart rate at 15min after induction of pneumoperitoneum in Group D -123.70±7.16 , 80.2±6.69, 94.68±5.28 , 71± 4.72 and Group F-133±6.81 , 85.00±4.8 , 101.42±3.73,86±4.2 respectively, the difference in SBP,DBP,HR between both groups was statistically significant p value 0.0001 and the difference were also statistically significant during intubation and extubation with ‘p’ values 0.0023 , 0.0001. Conclusion: Dexmedetomidine effectively attenuates stress response to pneumoperitoneum provides better intraoperative hemodynamic stability in laparoscopic surgeries when compared to Fentanyl.