CONTINUOUS INFUSION OF DEXMEDETOMIDINE TO ATTENUATE THE HEMODYNAMIC RESPONSE DURING LAPAROSCOPIC SURGERY IN CHILDREN

BACKGROUND Video laparoscopic surgeries have become popular in paediatric age group. However, the stress response to laparoscopic surgeries is high due to sympathetic stimulation and increased secretion of pituitary hormones. Dexmedetomidine is highly specific, potent, selective alpha 2 agonist which obtunds the hemodynamic stress response during laparoscopic surgeries by decreasing HR and MAP with concomitant decrease in cortisol, catecholamine and sympatholytic action also. Aims and Objectives- To evaluate the hemodynamic stress response to nociceptive stimuli in children submitted to video laparoscopic surgeries under balanced anaesthesia and IV Dexmedetomidine. MATERIALS AND METHODS This non-randomized, control trial study involving 30 ASA I and II children (1-12 years) posted for elective laparoscopic surgeries. Patients were assigned to 2 groups-Group D (Dexmedetomidine) and Group C (Control). All children were pre-medicated with oral midazolam 0.5 mg/kg. Basal HR, BP and SpO2 were recorded in all groups. Induced with Sevo + O-2 + Air. Group D received bolus infusion of Dexmedetomidine 1 mg/kg over 10 minutes followed by 1 mg/kg infusion as maintenance whereas Group C received normal saline infusion at similar rate and volume. During different surgical anaesthetic periods HR, SBP, DBP, ETCO2, SpO(2), InISO, EtISO and duration of surgeries were compared in both the groups. Need of supplemental Fentanyl was noted. RESULTS During the strongest nociceptive stimuli like laryngoscopy and abdominal port placement, the heart rate and systolic blood pressure increased significantly in Group C compared to Group D (At M-3 P-Value 0.008 and at M-4 0.037). The need for supplemental fentanyl and hemodynamic parameters were similar in both the groups. The sample size was taken for conveniences. CONCLUSION Continuous infusion of Dexmedetomidine as an adjuvant to inhaled isoflurane combined with isoflurane anaesthesia effectively attenuates the hemodynamic responses to noxious stimuli at various stages of the laparoscopic surgeries in children.