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Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine

Jean L. Joris, MD^*, Jean-Daniel Chiche, MD^*, Jean-Luc M. Canivet, MD^*, Nicolas J. Jacquet, MD, Jean Jacques Y. Legros, MD and Maurice L. Lamy, MD^*

^* Department of Anesthesiology and Intensive Care Medicine, University Hospital of Liège, Liège, Belgium
Department of Gastrointestinal Surgery, University Hospital of Liège, Liège, Belgium
Department of Endocrinology, University Hospital of Liège, Liège, Belgium

View larger version (29K): [in a new window]   Figure 1 Changes in SVR as well as in plasma concentrations of vasopressin and neurophysin during laparoscopic cholecystectomy (study 1). Systemic vascular resistance was calculated and arterial blood samples were collected before the induction of anesthesia (PRE-IND); 10 min after the induction of anaesthesia (POST-IND); 10 min after tilting into a 10° head-up position (HEAD-UP); 5 min (PNP 5), 15 min (PNP 15) and 30 min (PNP 30) after the beginning of insufflation; and 30 min after exsufflation (END). Results are mean ± SEM. *p < 0.05 compared with PRE-IND; p < 0.05 compared with HEAD-UP.

View larger version (37K): [in a new window]   Figure 2 Effect of 8 µg/kg clonidine infused over 1 h before peritoneal insufflation on hemodynamic changes induced by carbon dioxide PNO (study 2). Mean arterial pressure, heart rate, cardiac output and systemic vascular resistance were measured or calculated at the end of the infusion of clonidine or placebo and before the creation of the PNO (PRE-PNO); 5 min after the beginning of peritoneal insufflation with the patient in the supine position; 15 and 30 min after the beginning of insufflation with the patient tilted to a 10° head-up position; 5 min after exsufflation with the patient still tilted to a 10° head-up position (EXS-5); and finally 30 min after exsufflation, approximately 15 min after the end of anesthesia and tracheal extubation with the patient in a horizontal position breathing spontaneously (END). Results are mean ± SEM. *p < 0.05 compared with placebo; the increase in SVR was significantly (p < 0.05) less in the clonidine group (+394 ± 113 dynes·s·cm–5) than in the placebo group (+745 ± 49 dynes·s·cm–5); p < 0.05 compared with PNO 30 min.

View larger version (34K): [in a new window]   Figure 3 Effect of 8 µg/kg clonidine infused over 1 h before peritoneal insufflation on endocrine changes induced by carbon dioxide PNO (study 2). Vasopressin, epinephrine, norepinephrine and cortisol were measured at the same time points as in Figure 2. Results are mean ± SEM. *p < 0.05 compared with placebo.