title: Blood glucose estimation as an indirect assessment of modulation of neuroendocrine stress response by dexmedetomidine versus fentanyl premedication during laparoscopic cholecystectomy: A clinical study.
abstract: BACKGROUND
  Anesthesia and surgery-induced neuroendocrine stress response can be modulated by appropriate premedication. The present study was designed to assess the clinical efficacy of dexmedetomidine versus fentanyl premedication for modulation of neuroendocrine stress response by analyzing the perioperative variation of blood glucose level during laparoscopic cholecystectomy under general anesthesia.
  
  
  METHODS
  In a prospective randomized double-blind study, 60 adult consented patients of either sex with ASA I and II, scheduled for elective laparoscopic cholecystectomy under general anesthesia and meeting the inclusion criteria, were allocated into two groups. Group D patients (n = 30) were given intravenous dexmedetomidine 1μg/kg and Group F patients (n = 30) received fentanyl 2 μg/kg, given over a 10-min period, before induction of anesthesia. Perioperative blood glucose levels were analyzed preoperatively, at 30 min after beginning of surgery, and 2.5 h after surgery. Anesthetic and surgical techniques were standardized. All patients were also assessed for intraoperative hemodynamic changes of heart rate and mean arterial pressure at specific timings.
  
  
  RESULTS
  Blood glucose concentration has shown 20% increase after surgery. The differences between groups were not statistically significant as observed by analyzing the variation of serial perioperative blood glucose estimation. Both premedicants had attenuated the hemodynamic and neuroendocrine stress response of pneumoperitoneum and general anesthesia. The dexmedetomidine group showed more stabilization of intraoperative hemodynamics of mean arterial blood pressure and heart rate when compared to fentanyl group.
  
  
  CONCLUSIONS
  During the laparoscopic cholecystectomy, dexmedetomidine and fentanyl, both premedicants have effectively modulated the neuroendocrine stress response of general anesthesia as assessed by analysis of perioperative blood glucose variation, but dexmedetomidine was better.
authors.affiliation: Department of Anaesthesiology and Critical Care, Imaging and Interventional Radiology, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Kumkum
authors.initials: K
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesiology and Critical Care, Imaging and Interventional Radiology, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Aman
authors.initials: A
authors.lastname: Maggo
authors.affiliation: Department of Anaesthesiology and Critical Care, Imaging and Interventional Radiology, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Jain
authors.affiliation: Department of Radio-Diagnosis, Imaging and Interventional Radiology, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Prashant K
authors.initials: PK
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesiology and Critical Care, Imaging and Interventional Radiology, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Rastogi
authors.affiliation: Department of Anaesthesiology and Critical Care, Imaging and Interventional Radiology, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Apoorva B
authors.initials: AB
authors.lastname: Singhal
keywords: Dexmedetomidine; fentanyl; laparoscopic cholecystectomy; neuroendocrine stress response; pneumoperitoneum