Study of haemodynamic and endocrine stress responses following carbon dioxide pneumoperitonium

Abstract

Background: The aim of the study is to investigate the effect of oral gabapentin or clonidine versus placebo premedication on haemodynamic and endocrine responses in patients of American Society of Anesthesiology (ASA) physical status I and II undergoing laparoscopic cholecystectomy.

Methods: This was a randomized prospective double-blinded comparative study of 75 ASA I and II patients with three groups: clonidine, gabapentin and placebo group having 25 patients in each. They were randomly allocated to receive 600 mg oral gabapentin or clonidine 150 mcg one hour prior to induction of anesthesia and a placebo group. Hemodynamic parameters were recorded before pneumoperitonium (PP) and every 5 minutes till 35 minutes of post PP. Blood samples for serum glucose and cortisol were collected before PP and 10 mins after PP. The investigators were blinded to what the patients received.

Results: With similar demographic profiles and baseline haemodynamics in three groups (p>0.05) significant rise in haemodynamic parameters were observed in placebo group at different time points before and following PP where as those parameters remained stable in gabapentin and clonidine group (p<0.05). The serum cortisol level was high in placebo group before PP than in two other groups, p<0.05. The same marker measured at 10th minute after PP was significantly higher in placebo group than that in clonidine or gabapentin group, p<0.05.

Conclusions: Oral clonidine or gabapentin premedication offers intraoperative haemodynamic stability in laparoscopic cholecystectomy. When serum cortisol is taken as a stress marker, gabapentin group exhibited significant attenuation of stress of PP, p<0.05.