Efficacy and Safety of Dexmedetomidine in a Minimal Bolus Dose and as a Rescue Agent to Combat the Adverse Haemodynamic Effects During Laparoscopic Surgeries

Background: The aim of the study is to evaluate the effects of dexmedetomidine on attenuation of adverse hemodynamic effects that are caused due to various stimuli during intraoperative period of laparoscopic surgeries under general anaesthesia and provide smooth transition from intraoperative to post-operative period. Materials and Methods: 60 ASA grade I and II patients undergoing elective laparoscopic surgeries were enrolled for the study with 30 patients eachin group A and group B. Patients in group A received 20 mcg dexmedetomidine 10 min before induction and maintenance infusion of 0.6 mcg/kg/hr 10 min after gas insufflation. Patients in group B received induction drugs followed by incremental supplementation of fentanyl 0.5 mcg kg^-1, propofol 0.3 mg kg^-1) 10 min after gas insufflation to maintain hemodynamic parameters within 20% of baseline values. Results: There was no significant heart rate difference between both the groups after induction. Only significant increase was noted after gas insufflation in group B whereas blood pressure was significantly higher in group B immediately after induction of anaesthesia, after gas insufflation, deflation and immediately after extubation. Conclusion: A small bolus dose of dexmedetomidine before induction is effective in attenuating stress response to laryngoscopy and intubation without causing any adverse effects. However, there is a need for additional doses as rescue agent to attenuate response during oneumoperitoneum and for extubation.