Author/Editor		Novak-Jankovič, Vesna; Požar-Lukanović, Neva
Title		Vpliv intravenske premedikacije s klonidinom na hemodinamski stresni odgovor in porabo fentanila pri laparoskopskih odstranitvah žolčnika
Translated title		The influence of intravenous premedication with clonidine on haemodynamic stress response and fentanyl dosage during laparoscopic cholecystectomy
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 6, št. 15
Publication year		2001
Volume		str. 125-31
Language		slo
Abstract		Background. Induction of CO2 pneumoperitoneum in laparoscopic procedures increases sympathetic nervous activity, which may lead to tachycardia and hypertension. Numerous investigations have shown that clonidine, an alpha2 adrenergic agonist, reduces adrenergic haemodynamic response to surgical stimulation. The aim of this study was evaluate the role of clonidine premedication used with peritoneal CO2 insufflation in preventing hypertension and tachycardia, and in reducing fentanyl dosage during laparoscopic cholecystectomy. Patients and methods. Sixty ASA I-III patients, planned for laparoscopic cholecystectomy, were randomly assigned to either a clonidine or control group. The study group was premedicated with clonidine (4 mikro g/kg b.w.), given in an infusion 15 min before inducing anaesthesia. Standard anaesthesia administration and intraoperative monitoring were used in both groups. Differences in blood pressure, heart rate and fentanyl consumption between the groups were determined. Results. There were no differences in demographic parameters between the groups. Hypertension of > 180 mm Hg occurred in none of the clonidine patiemts but in 16 per cent of the controls (p<0,05). Systolic, men and diastolic blood pressures determined after pneumoperitoneum induction and at the end of the operation were significantly lower in the clonidine group relative to the control group (p4=0.02, p5=0.02). The difference between the groups concerning the decrease of heart rate below 50 beats/min was not statistically significant. The consumption of fentanyl was significantly lesser in the clonidine group than in the controls (4,8 mikro g/kgbw/min vs 2.9 mikro g/kgbw/min, p<0.003). (Abstract truncated at 2000 characters).
Summary		Izhodišče. Znano je, da izvedba pnevmoperitoneja pri laparoskopskih posegih poveča aktivnost simpatičnega živčevja, kar lahko povzroči porast krvnega tlaka in frekvenco srčnega utripa. Številne raziskave so pokazale, da klonidin, vzburjevalec adrenergičnih receptorjev alfa2, zmanjša adrenergični hemodinamski stresni odgovor na kirurški poseg. Deluje tudi sedativno in zmanjša porabo analgetikov. Želeli smo ugotoviti, kakšen je učinek intravenske premedikacije s 4 mikro g/kg klonidina na krvni tlak, utrip srca in porabo fentanila pri bolnikih med laparoskopsko odstranitvijo žolčnika. Bolniki in metode. 60 bolnikov iz I-III skupine po ASA klasifikaciji, pri katerih je bila načrtovana laparoskopska odstranitev žolčnika, smo naključno razdelili v dve skupini: klonidinsko in kontrolno. Bolnikom iz klonidinske skupine smo dali 4 mikro g/kg klonidina v infuziji 15 min. pred uvodom v anestezijo. Anestezija in nadzor med operacijo sta bila standardna in enaka v obeh skupinah. Primerjali smo spremembe krvnega tlaka, hitrost srčnega utripa in porabo fentanila. Rezultati. Demografski parametri se v skupinah niso razlikovali. Pri nobenem bolniku iz klonidinske skupine po izvedbi pnevmoperitoneja nismo zasledili povišanega sistoličnega krvnega tlaka nad 180 mmHg, pri kontrolni skupini pa pri 16% bolnikov (p<0,05). Sistolični, srednji in diastolični tlak po nastanku pnevmoperitoneja in po koncu operacije so bili pri klonidinski skupini pomembno nižji kot v kontrolni skupini (p4=0,02, p5=0,02). Razlika v upočasnitvi srčnega utripa pod 50 utripov/min med skupinama je bila statistično pomembna (p<0.05). Poraba fentanila je bila v klonidinski skupini pomembno manjša kot v kontrolni skupini (4,8 mikro g/kgtt/min proti 2,9 mikro g/kgtt/min, p<0,003). (Izvleček prekinjen pri 2000 znakih).
Descriptors		CHOLECYSTECTOMY, LAPAROSCOPIC PREMEDICATION CLONIDINE FENTANYL HEMODYNAMICS BLOOD PRESSURE HEART RATE