Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trial
Background: Enhanced Recovery After Surgery (ERAS) programs represent a shift in perioperative care, combining evidence-based interventions to reduce surgical stress to expedite recovery. ERAS requires cohesive team efforts to facilitate early discharge and reduce hospital stays. Anaesthesia and pne...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-04-01
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| Series: | Journal of Minimal Access Surgery |
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| Online Access: | https://journals.lww.com/10.4103/jmas.jmas_69_24 |
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| author | Sucheta Gaiwal J H Palep Rohini Mirkute Nimitha Prasad Mehta Kush |
| author_facet | Sucheta Gaiwal J H Palep Rohini Mirkute Nimitha Prasad Mehta Kush |
| author_sort | Sucheta Gaiwal |
| collection | DOAJ |
| description | Background:
Enhanced Recovery After Surgery (ERAS) programs represent a shift in perioperative care, combining evidence-based interventions to reduce surgical stress to expedite recovery. ERAS requires cohesive team efforts to facilitate early discharge and reduce hospital stays. Anaesthesia and pneumoperitoneum management within ERAS play crucial roles in influencing postoperative outcomes. Laparoscopic cholecystectomy is widely acknowledged as the foremost approach for managing symptomatic gallstone disease due to its minimally invasive nature and favourable recovery. It has been demonstrated that increased abdominal pressures with prolonged CO2 exposure produce changes in cardio-vascular and pulmonary dynamics, which can be minimized by insufflating at minimum pressure required for adequate exposure, as advocated by European endoscopic guidelines. Dexmedetomidine, a highly selective alpha-2 adrenoreceptor agonist, has gained attention in anaesthesia armamentarium due to its sedative, analgesic, sympatholytic, and opioid-sparing properties. For multimodal opioid sparing postoperative pain management it’s advantageous.
Aim:
To evaluate combined effect of low-pressure pneumoperitoneum and intra-operative dexmedetomidine infusion in laparoscopic cholecystectomy for ERAS.
Patients and Methods:
160 patients of American Society of Anaesthesiologists (ASA) score 1 and 2, undergoing elective laparoscopic cholecystectomy were randomized into low pressure pneumoperitoneum (10-12 mmHg) and standard pressure pneumoperitoneum (13-15 mmHg) groups. Each group is subdivided into, no Dexmedetomidine (ND) and with Dexmedetomidine (WD) infusion (0.7 mcg/kg/hr) intra-operatively. Thus, 40 patients in each of the 4 study arms. Perioperative variables were collected and analysed.
Results and Conclusions:
Low pressure pneumoperitoneum with intra-operative Dexmedetomidine infusion (0.7 mcg/kg/hr) resulted in stable hemodynamics, reduced post-operative pain, no requirement of additional analgesics and early discharge. Thus, synergistic impact of these interventions significantly improved postoperative outcomes when used as part of ERAS protocols. |
| format | Article |
| id | doaj-art-b79dbf87aa8141f3acc8ab5b372bf9f9 |
| institution | DOAJ |
| issn | 0972-9941 1998-3921 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Minimal Access Surgery |
| spelling | doaj-art-b79dbf87aa8141f3acc8ab5b372bf9f92025-08-20T02:57:12ZengWolters Kluwer Medknow PublicationsJournal of Minimal Access Surgery0972-99411998-39212025-04-0121214715210.4103/jmas.jmas_69_24Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trialSucheta GaiwalJ H PalepRohini MirkuteNimitha PrasadMehta KushBackground: Enhanced Recovery After Surgery (ERAS) programs represent a shift in perioperative care, combining evidence-based interventions to reduce surgical stress to expedite recovery. ERAS requires cohesive team efforts to facilitate early discharge and reduce hospital stays. Anaesthesia and pneumoperitoneum management within ERAS play crucial roles in influencing postoperative outcomes. Laparoscopic cholecystectomy is widely acknowledged as the foremost approach for managing symptomatic gallstone disease due to its minimally invasive nature and favourable recovery. It has been demonstrated that increased abdominal pressures with prolonged CO2 exposure produce changes in cardio-vascular and pulmonary dynamics, which can be minimized by insufflating at minimum pressure required for adequate exposure, as advocated by European endoscopic guidelines. Dexmedetomidine, a highly selective alpha-2 adrenoreceptor agonist, has gained attention in anaesthesia armamentarium due to its sedative, analgesic, sympatholytic, and opioid-sparing properties. For multimodal opioid sparing postoperative pain management it’s advantageous. Aim: To evaluate combined effect of low-pressure pneumoperitoneum and intra-operative dexmedetomidine infusion in laparoscopic cholecystectomy for ERAS. Patients and Methods: 160 patients of American Society of Anaesthesiologists (ASA) score 1 and 2, undergoing elective laparoscopic cholecystectomy were randomized into low pressure pneumoperitoneum (10-12 mmHg) and standard pressure pneumoperitoneum (13-15 mmHg) groups. Each group is subdivided into, no Dexmedetomidine (ND) and with Dexmedetomidine (WD) infusion (0.7 mcg/kg/hr) intra-operatively. Thus, 40 patients in each of the 4 study arms. Perioperative variables were collected and analysed. Results and Conclusions: Low pressure pneumoperitoneum with intra-operative Dexmedetomidine infusion (0.7 mcg/kg/hr) resulted in stable hemodynamics, reduced post-operative pain, no requirement of additional analgesics and early discharge. Thus, synergistic impact of these interventions significantly improved postoperative outcomes when used as part of ERAS protocols.https://journals.lww.com/10.4103/jmas.jmas_69_24dexmedetomidineenhanced recovery after surgerylaparoscopic cholecystectomypneumoperitoneum |
| spellingShingle | Sucheta Gaiwal J H Palep Rohini Mirkute Nimitha Prasad Mehta Kush Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trial Journal of Minimal Access Surgery dexmedetomidine enhanced recovery after surgery laparoscopic cholecystectomy pneumoperitoneum |
| title | Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trial |
| title_full | Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trial |
| title_fullStr | Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trial |
| title_full_unstemmed | Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trial |
| title_short | Low-pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery: A prospective randomised controlled clinical trial |
| title_sort | low pressure pneumoperitoneum with intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy for enhanced recovery after surgery a prospective randomised controlled clinical trial |
| topic | dexmedetomidine enhanced recovery after surgery laparoscopic cholecystectomy pneumoperitoneum |
| url | https://journals.lww.com/10.4103/jmas.jmas_69_24 |
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