Effect of premedication with oral clonidine on hemodynamics and recovery status of patients undergoing laparoscopic cholecystectomy

Abstract

Laparoscopic cholecystectomy is one of the most commonly undertaken procedures in general surgery, with the overall complication rate being less than 1.5%, and the mortality is less than 0.1%. However, the pneumoperitoneum (PNP) required for this procedure shows a higher degree of intraoperative cardiovascular instability and postoperative nausea and vomiting (PONV). The nature of changes in the cardiovascular system associated with pneumoperitoneum includes an increase in mean arterial pressure, decrease in cardiac output, and increase in systemic vascular resistance which can lead to altered tissue perfusion. Hypercarbia and relatively high prevalence of nausea and vomiting occur after CO2 uptake. Considering the positive effect of agonist 2α on hemodynamic parameters and recovery complications in various surgeries, we decided to investigate the effect of premedication with oral clonidine on hemodynamics and recovery status of patients undergoing laparoscopic cholecystectomy.

Methods: In this randomized clinical trial with parallel groups, double-blind, 120 candidates for laparoscopic cholecystectomy surgery from January 2018 to July 2019 were included in the study. Patients were randomly divided into intervention and control groups. The patient in the intervention group received a 0.2 mg clonidine tablet one and a half hours before entering the operating room and the control group received the same amount of placebo. The patient's hemodynamic status before anesthesia, after intubation, during surgery and in recovery, the amount of shivering, nausea and vomiting after surgery, and the amount of analgesic and anti-nausea drugs used in recovery were recorded. The collected data were analyzed by SPSS software version of Windows 22. Results: In this study, administration of oral clonidine before surgery was more effective in reducing mean arterial pressure (MAP) and heart rate (HR) variables than the control group (p=0.001) and also in the clonidine pain group (p=0.04), shivering (p=0.03) and nausea and vomiting (p=0.04) after surgery, the use of opioid drugs (p=0.05) and antiemetics (p=0.04) had a significant decrease in recovery.