Comparison of Perioperative Hemodynamic Responses of Intravenous Dexmedetomidine and Esmolol Carbon Dioxide Pneumoperitoneum During Laparoscopic Surgery

Abstract

Background: Laparoscopic surgery has many advantages, including less blood loss, smaller incisions, less pain, shorter recovery time, and less exposure of internal organs to possible external contamination, thereby reducing the risk of infection. Carbon dioxide pneumoperitoneum during laparoscopic surgery increases arterial pressure, heart rate, and systemic vascular resistance.

Methods: This prospective randomized study was conducted from July 2023 to August 2024 after taking approval by the Institutional Ethics Committee of BSMMU Dhaka, Bangladesh and written informed consent from the patients. 60 patients of both sexes undergoing elective laparoscopic cholecystectomy were randomly divided into three groups of 20 patients each. Group A received a 500 mcg/kg bolus of esmolol before pneumoperitoneum followed by an infusion of 100 mcg/kg/min. Group B received a 1 μg/kg intravenous bolus of dexmedetomidine before pneumoperitoneum followed by an infusion of 0.2 μg/kg/h. Group C (control) received 0.9% saline.

Results: Sixty patients, of either sex undergoing elective laparoscopic cholecystectomy, were randomly allocated into three groups containing twenty patients each. The patients allocated into the Group A, Group B, and Group C was comparable with respect to age, distribution of gender, body weight, and the duration of surgery. No significant difference was found regarding the preoperative MAP and the MAP values following intubation and before pneumoperitoneum among all three groups (P >0.05). Mean arterial pressure and HR in Group A and D were significantly less throughout the period of pneumoperitoneum in comparison to Group C. IV nitroglycerine was required in 45% (9 out of 20) patients in Group C to control intraoperative hypertension, and it was clinically significant in comparison to Group A and D.

Conclusion: In conclusion, both esmolol and dexmedetomidine effectively reduce the increase in MAP and HR during and after pneumoperitoneum, thereby providing hemodynamic stability during laparoscopic surgery. There is no significant difference between the efficacy of esmolol and dexmedetomidine in reducing the hemodynamic response to pneumoperitoneum or laparoscopic surgery.