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Dr. Komal Paswan
Dr. Badri Prasad Das
Dr. Anup Kumar Harichandan
Dr. Sudhansu Sekhar Nayak
Dr. Gyanendra Kumar Sinha


Laparoscopic Cholecystectomy, TIVA, Dexmedetomidine, Magnesium Sulfate, BIS, ANI


BACKGROUND: Laparoscopic cholecystectomy is a routinely performed surgery always demanding a stable intraoperative hemodyanamic status. The pneumoperitonium and the patient positions required for laparoscopy induce pathophysiologic changes that complicate anaesthetic management. And search for an ideal anaesthetic adjuvant for attenuating such changes is still on. The present study was conducted to compare the effects of dexmedetomidine and magnesium sulfate as adjuvant in maintaining perioperative cardiovascular stability, with propofol consumption as a part of total intravenous anaesthesia (TIVA) and postoperative analgesia in laparoscopic cholecystectomy, with Bispectral index (BIS), and Analgesia and Nociception Index (ANI) as a guidance.

MATERIAL AND METHODS: After thorough pre-anaesthetic check-up, 60 adult patients aged 20-60yrs with ASA physical status of I and II, belonging to either sex and scheduled for undergoing laparoscopic cholecystectomy, were randomly allocated into two groups of 30 each, using computer generated random table, to receive blinded study drugs:

Group 1: received magnesium sulfate 30mg/kg bolus (made to 20ml saline) infused over 20min, 20min before induction, followed by 15mg/kg/hr.

Group 2: received dexmedetomidine at a bolus dose of 1 mcg/kg (made to 20ml saline) infused over 20min, 20 min before induction, followed by 0.5 mcg/kg/hr.

This study was carried over a period of 15 month.

Statistical analysis was done using SPSS version 20.0. Sample size was calculated using previous similar studies, and keeping α <5 % and β= 20%, power of study=80%. Mean ± SD and Student's t-test was used for statistical analysis and comparison of age, weight, haemodynamic parameters, dose of study drugs used, dose of propofol, time to extubation, and the use of rescue analgesia between the two groups, with a p-value of <0.05 considered significant.

RESULTS: In our study we found that the mean requirement of propofol in group 1 at the time of induction in mg was 57.00±9.52 and in group 2 it was 58.33±9.85 with no significant difference (p=0.596). With maintenance infusion of magnesium and dexmedetomidine in the recommended mean dose (15mg/kg/hr and 0.5mcg/kg/hr respectively), the mean requirement of propofol infusion for maintenance of depth of anaesthesia (to maintain BIS and ANI 40-60) was 133.33±41.91 mg (in group 1) and 183.33+51.107 mg (in group 2) with a statistical significant difference (p= 0.03). Thus, there was a significant propofol sparing effect of around 56 mg, with magnesium use. With 1 ampule of magnesium sulfate being Rs 8.50 and 1 ampule of dexmedetomidine being Rs. 759, the mean cost was 152.4+22.2 and 909.4+22.2 respectively. Hence we got a significant cost effectiveness for patients with magnesium use. Therefore as per this study the sedative property is almost equal in both drugs and less propofol required to maintain adequate depth of anaesthesia in magnesium sulfate.

CONCLUSION: Hence, this study concludes that magnesium sulfate shows a promising role as an adjunct to total intravenous anesthesia (TIVA) for patients undergoing laparoscopic cholecystectomy. It offers comparable intraoperative hemodynamics, a higher propofol-sparing effect for maintaining general anesthesia, better postoperative analgesia, with cost-effectiveness, as compared to dexmedetomidine.

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