title: Effects of dexmedetomidine and clonidine as propofol adjuvants on intra-operative hemodynamics and recovery profiles in patients undergoing laparoscopic cholecystectomy: A prospective randomized comparative study.
abstract: BACKGROUND
  Alpha-2 (α2) adrenergic receptor agonists, clonidine and dexmedetomidine, are widely used as adjuvants during anesthesia for analgesic, sedative, sympatholytic, and cardiovascular stabilizing effects.
  
  
  OBJECTIVE
  We compared effects of clonidine and dexmedetomidine (as propofol adjuvants) on intra-operative hemodynamics, recovery time, and postoperative cognitive function impairment.
  
  
  METHODS
  Forty-five American Society of Anesthesiologists I and II patients, scheduled for laparoscopic cholecystectomy were divided into three groups (n = 15). Group C patients received bolus of clonidine 3 μg/kg followed by a continuous infusion; Group D patients received dexemedetomidine 1 μg/kg and a continuous infusion; and Group P patients received a bolus of normal saline followed by an infusion. Intra-operative mean arterial pressure (MAP) and pulse rate (PR) were measured throughout the surgery. Bispectral index was maintained at 55 ± 5 by titrating propofol infusion rate. The time between the interruption of anesthesia and eye opening (recovery time) was measured. Cognitive function was assessed using short mental status questionnaire at 15, 30, 45, and 60 min postoperatively.
  
  
  RESULTS
  The sympathetic response to laryngoscopy and extubation on MAP and PR were significantly reduced with the use of clonidine and dexmedetomidine (P < 0.05). The recovery was delayed (P < 0.05) with both the drug combinations and it was more pronounced with dexmedetomidine (P < 0.05). Dexmedetomidine group showed cognitive impairment in a postoperative period lasting up to an hour.
  
  
  CONCLUSIONS
  When co-administered with propofol, both clonidine, and dexmedetomidine attenuate sympathetic response to laryngoscopy and extubation but cause delay in the recovery from anesthesia. Dexmedetomidine causes impairment of postoperative cognitive functions.
authors.affiliation: Department of Anaesthesiology and Intensive Care, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Naz
authors.initials: N
authors.lastname: Anjum
authors.affiliation: Department of Functional Genomics, Institute of Genomics and Integrative Biology, New Delhi, India.
authors.forename: Hussain
authors.initials: H
authors.lastname: Tabish
authors.affiliation: Department of Anaesthesia and Critical Care, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Saha
authors.initials: S
authors.lastname: Debdas
authors.affiliation: Department of Anaesthesiology and Intensive Care, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Hembrom P
authors.initials: HP
authors.lastname: Bani
authors.affiliation: Department of Anaesthesiology and Intensive Care, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Choudhuri
authors.initials: C
authors.lastname: Rajat
authors.affiliation: Department of Anaesthesiology and Intensive Care, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Ghosh Dastidar
authors.initials: GD
authors.lastname: Anjana Basu
keywords: Clonidine; cognitive dysfunction; dexmedetomidine; hemodynamics; recovery time