Clonidine provides opioid-sparing effect, stable hemodynamics, and renal integrity during laparoscopic cholecystectomy.
BACKGROUND
Carbon dioxide pneumoperitoneum causes a hemodynamic stress response and decreases urine output because of an activated renin-angiotensin-aldosterone system (RAAS). Clonidine is a potent antihypertensive drug that suppresses RAAS.


METHODS
The effects of clonidine 4.5 mg/kg or saline on hemodynamics, neuroendocrine response, and renal parameters were compared in 30 healthy patients undergoing laparoscopic cholecystectomy.


RESULTS
Heart rate, arterial blood pressures, and plasma renin activity were lower during and after pneumoperitoneum in patients with clonidine. There were no differences in urine output, urine oxygen tension (reflecting medullary perfusion), or antidiuretic hormone between the groups. N-acetyl-b-D-glucosaminidase, a marker of proximal tubular damage, was minimally elevated after clonidine.


CONCLUSIONS
Clonidine enabled stable hemodynamics and prevented activation of RAAS seen as unchanged plasma renin activity. Clonidine may be beneficial during laparoscopy in patients with hypertension, cardiovascular, and/or renal diseases.
Laisalmi
M
M
Department of Anaesthesia and Intensive Care Medicine, Surgical Hospital, Helsinki University Central Hospital, 00029 HUS Helsinki, Finland. merja.laisalmi@hus.fi
Koivusalo
A M
AM
Valta
P
P
Tikkanen
I
I
Lindgren
L
L
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003000:Clonidine / Q000008:administration & dosage*; D004311:Double-Blind Method; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007273:Injections, Intramuscular; D007677:Kidney Function Tests; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011292:Premedication; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects
D000959:Antihypertensive Agents; D012083:Renin; D003000:Clonidine