sábado, 12 de abril de 2014

Histerectomía laparoscópica/Laparoscopic hysterectomy

Estudio comparativo con clonidina vs. lidocaína para atenuar las respuestas hemodinámicas durante histerectomía laparoscópica

Comparative study of clonidine versus lignocaine for attenuation of hemodynamic responses during laparoscopic hysterectomy.
Roy S, Chaudhuri A, Saha D, Maulik SG, Bandopadhyay AK.
J Basic Clin Reprod Sci [serial online] 2014 [cited 2014 Mar 21];3:38-43.
Background: Hemodynamic changes due to reflex sympathetic discharge are of great concern in laparoscopic surgeries. Aim: To compare hemodynamic changes following premedication with lignocaine or clonidine during laparoscopic hysterectomy. Subjects and Methods: This prospective cross-sectional randomized double blinded controlled trial was conducted one year in a tertiary care hospital in West Bengal. After taking institutional ethical clearance and consent of patients, hundred subjects of ASA Grade I and II undergoing elective laparoscopic hysterectomy were included in the study. Patients were allocated into two groups. Group A received clonidine and Group B received lignocaine. Baseline clinical parameters were recorded. Patients received clonidine or lignocaine as a bolus over a period of 15 minutes before induction and as continuous intravenous infusion throughout the surgical procedure. The dose of clonidine was 2.25 μg/kg bolus and 0.9 μg/kg/hr infusion while that of lignocaine was 1.5 mg/kg bolus and 0.6 mg/kg/hr infusion. Patients were given 1 μg/kg of fentanyl citrate intravenously. Following inductionwith intravenous propofol, endotracheal intubation was facilitated by atracurium. Anaesthesia was maintained by nitrous oxideIN and oxygen and along with propofol infusion. Muscle relaxation was achieved by intermittent bolus doses of atracurium. The patients were mechanically ventilated to keep EtCO 2 between 35 and 40 mm Hg. Residual neuromuscular block was reversed by an appropriate dose of neostigmine and glycopyrrolate. All patients were shifted to PACU/POCU. Ramsay Sedation Score was assessed. Data was analyzed using SPSS version 16. Results: In comparison to group B, attenuation of heart rate, Systolic blood pressure, diastolic blood pressures were significantly more in group A. There was no difference in sedation score between the two groups. Conclusion: In an attempt to attenuate both the effects of layngoscopy and insufflations with carbon dioxide in laparoscopic surgery infusions of clonidine and lignocaine were run all through the procedures in the present study and it was found that use of clonidine and lignocaine attenuated the haemodynamic responses. However clonidine being found to be more effective.
Keywords: Clonidine, hemodynamic responses, hysterectomy, lignocaine




Anestesiología y Medicina del Dolor
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