European Journal of Cardiovascular Medicine

Laparoscopic surgeries have revolutionized the field of surgery and are the gold standard technique for many conditions. It involves insufflations of gas (usually co2) into the peritoneal cavity. Despite multiple benefits, all laparoscopic surgeries are challenging from an anaesthesia point of view, due to significant alteration of haemodynamics, pneumoperitoneum and patient positioning1. Hypercapnia and pneumoperitoneum cause stimulation of sympathetic nervous system, catecholamine and vasopressor release.2 These haemodynamics changes can be attenuated by appropriate premedication. 2

Dexmedetomidine is a highly selective and potent alpha-2 adrenergic agonist.1 It has higher affinity for alpha -2 receptors than clonidine. It has sedative, analgesic and sympatholytic effect which blunts cardiovascular instability perioperatively. Clonidine is a selective partial alpha 2 agonist, has antihypertensive effects and provides good post-operative analgesia.2 During general anaesthesia, it enhances cardiovascular stability by reducing catecholamine levels. Both the drugs are known to induce preoperative sedation, intraoperative reduction of anaesthetic and analgesic requirement and haemodynamic stability.3 Clonidine is a selective alpha 2 agonist with a short half-life of less than 10 hrs. It is known for its sedation action, maintaining the perioperative hemodynamic stability and there by reduces the dose requirement of anaesthesia. 4,5 Laparoscopic cholecystectomy being a routinely performed surgery maintaining stable hemodynamic mechanism is of utmost important and very few studies as of today had compared clonidine and dexmedetomidine as preferred drug for maintenance of the hemodynamic system and so the current study was undertaken.6

Objective: To compare the efficacy of Dexmedetomidine and clonidine as pre anaesthetic medication in perioperative haemodynamic stability.

Type of Study: Experimental Study

Place of Study: Department of anaesthesiology at tertiary care centre

Duration of Study: January 2024 to June 2024 (6 months)

Study population: We have 2 study groups; Patients will be divided into group 1 (patients given dexmedetomidine) and group 2 (patients given clonidine).

Inclusion Criteria:

1.       Patients to be posted for laparoscopic surgeries.

2.       Patients aged between 20-60 years of age

3.       American Society of Anaesthesiologists grade 1 and 2

4.       Patients with written informed valid consent.

Exclusion Criteria:

1.       Patients below 20 years and above 60 years of age

2.       Patients with known chronic liver disease, known renal disease, neurological disease, cardiovascular disease, chronic respiratory diseases.

3.       Pregnant women and lactating mothers.

4.       American Society of Anaesthesiologists grade 3 and 4

5.       Patient refusal

Statistical analysis:

Data will be collected by using proforma. Data will be entered in excel sheet and analysed using SSPS statistical software. Qualitative data will be expressed as percentage and quantitative data will be expressed as mean and standard deviation. Patients will be divided into group 1 (patients given dexmedetomidine) and group 2 (patients given clonidine). Comparison of mean between group 1 and group 2 will be done by using unpaired t test. P<0.05 will be considered as significant and p<0.001 will be considered as highly significant.

Table 1: Distribution according to age group

We included 52 patients in each group. In clonidine group, majority of the cases were from 41-50 years i.e. 38.5% followed by 28.8% from 31-40 years. In Dexmedetomidine group, majority of the cases were from 41-50 years i.e. 32.7% followed by 26.9% each from 31-40 years and less than 30 years age group.

Table 2: Comparison of SBP between Clonidine and Dexmedetomidine

We compared the SBP at different time intervals between Clonidine and Dexmedetomidine and observed that there was statistically significant difference between two groups before and after induction, at 10,20,80,100,120 minutes and 10 minutes after extubation and post operatively 1 hour after. (p<0.05). Dexmedetomidine was found to keep the SBP at lower side in our study.

Table 3: Comparison of DBP between Clonidine and Dexmedetomidine

We compared the DBP at different time intervals between Clonidine and Dexmedetomidine and observed that there was statistically significant difference between two groups before and after induction, at 10,20,80,100,120 minutes and post operatively 1 hour after. (p<0.05). Dexmedetomidine was found to keep the DBP at lower side in our study.

Table 4: Comparison of MAP between Clonidine and Dexmedetomidine

We compared the MAP at different time intervals between Clonidine and Dexmedetomidine and observed that there was statistically significant difference between two groups after induction, at 10,20,80,100,120 minutes and post operatively 1 hour after. (p<0.05). Dexmedetomidine was found to keep the MAP at lower side in our study.

We compared the HR at different time intervals between Clonidine and Dexmedetomidine and observed that there was statistically significant difference between two groups after induction, at 10,20,80,100,120 minutes and post operatively 1 hour after. (p<0.05). Dexmedetomidine was found to keep the HR at lower side in our study.

We included 52 patients in each group. In clonidine group, majority of the cases were from 41-50 years i.e. 38.5% followed by 28.8% from 31-40 years. In Dexmedetomidine group, majority of the cases were from 41-50 years i.e. 32.7% followed by 26.9% each from 31-40 years and less than 30 years age group. 46.2% and 71.2% females were from Clonidine and Dexmedetomidine group respectively. 53.8% and 28.8% males were from Clonidine and Dexmedetomidine group respectively. (Table 1 and Figure 1) We compared the SBP at different time intervals between Clonidine and Dexmedetomidine and observed that there was statistically significant difference between two groups before and after induction, at 10, 20,80,100,120 minutes and 10 minutes after extubation and post operatively 1 hour after. (p<0.05). Dexmedetomidine was found to keep the SBP at lower side in our study. (Table 2) We compared the DBP at different time intervals between Clonidine and Dexmedetomidine and observed that there was statistically significant difference between two groups before and after induction, at 10, 20,80,100,120 minutes and post operatively 1 hour after. (p<0.05). Dexmedetomidine was found to keep the DBP at lower side in our study. (Table 3) We compared the MAP at different time intervals between Clonidine and Dexmedetomidine and observed that there was statistically significant difference between two groups after induction, at 10,20, 80,100,120 minutes and post operatively 1 hour after. (p<0.05). Dexmedetomidine was found to keep the MAP at lower side in our study. (Table 4) We compared the HR at different time intervals between Clonidine and Dexmedetomidine and observed that there was statistically significant difference between two groups after induction, at 10, 20, 80,100,120 minutes and post operatively 1 hour after. (p<0.05). Dexmedetomidine was found to keep the MAP at lower side in our study. (Figure 2) Rajaprabu T. et al7 compared the efficacy of clonidine with dexmedetomidine on hemodynamic stability among patients undergoing laparoscopic cholecystectomy. A placebo group was taken as a control. They found no significant change in the heart rate and blood pressure among both the study groups in comparison with the placebo group. In a study done by Taittonen et al8 comparing clonidine 4mcg/kg with dexmedetomidine 2.5 mcg/kg had found that the heart rate and MAP was significantly lower in both these group in comparison with the placebo group. A study done by Hall JE et al9 on comparing between clonidine and placebo group had found an increase in MAP and a decrease in MAP in placebo and clonidine groups respectively in comparison with the baseline values which is in par with our study and Another conducted by Das M. et al10 in 2007 had also quoted a similar type of results.

A recent study done by Singh S. et al11 had monitored the MAP intaroperatively by giving 150 mcg of oral clonidine before induction and found that the perioperative MAP was lower at all time in the clonidine group compared to the placebo group. Another study done by Tufanogullari et al12 and Bhattacharjee et al comparing between different doses of dexmedetomidine with the placebo group among the patients undergoing laparoscopic cholecystectomy and they found a significant increase in MAP and heart rate in the placebo group whereas in the dexmedetomidine group there was no significant rise and the usage of isoflurane is more in placebo and the results are in par with our study.

We can conclude that Clonidine and Dexmedetomidine both are effective in maintaining the hemodynamic stability but Dexmedetomidine is more effective than Clonidine.

1.       Bharti D, Saran J, Kumar C, Nanda HS. Comparison of Clonidine and Dexmedetomidine on Cardiovascular Stability in Laparoscopic Cholecystectomy. Int J Sci Stud 2016;4(1):43-50

2.       Kumar V, Anil. (2015). Comparison of Dexmedetomidine and Clonidine (𝛼 2 agonist drugs) in laparoscopic appendicectomy under G.A. Journal of Evidence Based Medicine and Healthcare. 2015;2(30):4419-27.

3.       Singh S, Nazir A. A comparative study of effect of dexmedetomidine in dose of 0.7ug/kg and clonidine in doses of 2ug/kg as premedication before general anaesthesia. Int J Res Med Sci 2016;4;3365-9.

4.       S Kumar, B B Kushwaha, R Prakash, et al. Comparative study of effects of dexmedetomidine and clonidine premedication in perioperative hemodynamic stability and postoperative analgesia in laparoscopic cholecystectomy. The Internet Journal of Anaesthesiology 2014;33 (1).

5.       Hazra R, Manjunatha SM, Manuar MDB, Basu R, Chakraborty S. Comparison of the effects of intravenously administered dexmedetomidine with clonidine on hemodynamic responses during laparoscopic cholecystectomy. Anaesth Pain & Intensive Care 2014;18(1):25-30.

6.       Chiruvella Sunil, Donthu B, Siva JV, Dorababu S. Comparative Study of clonidine versus dexmedetomidine for hemodynamic stability during laparoscopic cholecystectomy. Int J Sci Stud 2014;2(7):186-190.

7.       Rajaprabu T, Kumar V. Comparison between the hemodynamic stability of dexmedtomidine and clonidine infusions among patients undergoing laparoscopic cholecystectomy-A randomized controlled trial. Indian Journal of Clinical Anaesthesia. 2019 Jul;6(3):437-40.

8.       Taitonnen T, Kirvela OA, Aantaa R, Kanto JH. Effect of clonidine and dexmedetomidine premedication on the perioperative oxygen consumption and hemodynamic state. BJA 1997;78:400-6.

9.       Hall Je, Barney JA, Toni D, Uhrich MS, Colinco M. The effects of increasing plasma concentrations of dexmedetomidine in Humans. Anesth 2000;93:382-94.

10.    Das M, Ray M, Mukherjee G. Hemodynamic changes during laproscopic cholecystectomy. Effect of clonidine premedication. IJA 2007;51(3):205-10.

11.    Singh S, Arora K. Effect of oral clonidine premedication on perioperative hemodynamic response and post-operative analgesic requirement of patients undergoing laproscopic cholecystectomy. IJA 2011;55(1):26-30.

12.    Tufanogullari B, White PF, Deixoto MP, Kianpour D, Lacour T, Griffin J et al. Dexmedetomidine infusion during laproscopic bariatric surgery. The effect on recovery outcome variables. Anesth Analg 2008;106 (6):1741-8.