A Comparative Study of Modulation of Neuroendocrine Stress Response by Dexmedetomidine versus Fentanyl Premedication during Laparoscopic Cholecystectomy

Surgical stress is the systemic response to surgical injury. Analyzing these surgical stress responses and pharmacologically modulating them can be of immense use to an anesthetist for optimal patient care.

The aim of the present study was to investigate the influence of dexmedetomidine and fentanyl premedication on the modulation of neuroendocrine stress response during laparoscopic cholecystectomy under general anesthesia.

After obtaining approval from the institutional ethical committee [Date - 05/11/2020, Ethical Clearence Number - 133/2018], 60 patients undergoing laparoscopic cholecystectomy under general anesthesia were randomized into three study groups of 20 patients each. Group D patients were given intravenous (i.v.) dexmedetomidine 1 μg.kg^-1, Group F patients fentanyl 2 μg.kg^-1 and Group C patients 10 mL of normal saline. All patients received the same anesthetic drugs and surgical procedure. Patients were assessed for changes in hemodynamic parameters such as heart rate (H) and mean arterial pressure (MAP). Blood samples were analyzed for glucose, serum albumin, C-reactive protein (CRP), and serum cortisol levels at various time intervals.

H and MAP differed among the groups after intubation, 5 min after pneumoperitoneum (POT), and 10 min after POT. The increase in these parameters from their baseline values was less in the dexmedetomidine group when compared to other groups. Among the biological markers, the increase in serum cortisol levels and decrease in albumin levels could be detected 6 h after induction while blood glucose levels rose immediately after the incision. CRP levels started significantly rising only after 24 h of induction. All these changes were much less pronounced in patients receiving dexmedetomidine premedication as compared to other groups.

i.v. dexmedetomidine 1 μg.kg^-1 is better than injection fentanyl 2 μg.kg^-1, in the modulation of neuroendocrine response in patients undergoing laparoscopic cholecystectomy under general anesthesia.