Comparison Of Dexmedetomidine and Fentanyl In Attenuation Of Hemodynamic Response To Direct Laryngoscopy And Intubation In Patient Undergoing Laparoscopic Cholecystectomy.

Study Overview
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Brief Summary
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Compare effects of intravenous dexmedetomidine and fentanyl in attenuation of intubation response in a patient undergoing laparoscopic cholecystectomy. Compare the effects of intravenous dexmedetomidine and fentanyl in sedation, perioperative complications, and recovery in these patients. Dexmedetomidine is comparatively a newer drug in countries like Pakistan. There is no research work available at the national level and scarcity of data at an international level with inconclusive outcomes. Our participation in the form of this research will add to scientific literature and step up ahead at the international level. Fentanyl citrate is a narcotic analgesic interacting predominantly with the opioid μ receptor and exerting its principal pharmacological effect on CNS. Its primary action of therapeutic value is analgesia and sedation. It is extensively used for anesthetic and analgesic most often in operating room and ICU.

Detailed Description
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This is double-blind, a single centered randomized clinical trial which is based on assessing the hemodynamic stability provided by our study drugs during laryngoscopy and intubation in a patient undergoing laparoscopic cholecystectomy. In addition to that this study will assess the perioperative complication and postoperative recovery in these patients. Laparoscopy has now become the standard technique of choice for cholecystectomy which results in pathophysiological changes characterized by an increase in arterial pressure and heart rate (HR). Many types of research have been done in an attempt to minimize adverse effects by adding adjuvants to the conventional method of general anesthesia. Our research is also based on this aim. The objective of this study to determine the hemodynamic stability during laryngoscopy and intubation, peri-operative complication and post-operative recovery. The patients will be divided into two groups randomly and will be given the desired drugs via intravenous line by on floor consultant anesthetist who will be blinded to the drug. The study subjects' hemodynamics will be observed until 10 minutes of intubation. Any perioperative complication will be noted. The subjects will also be followed postoperatively in recovery to check there sedation score and recovery (Aldrete score) will be noted after 10 minutes after the patient shifted to recovery.

Official Title
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Comparison Of Dexmedetomidine and Fentanyl In Attenuation Of Hemodynamic Response To Direct Laryngoscopy And Intubation In Patient Undergoing Laparoscopic Cholecystectomy.

Conditions
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Cholecystectomy, Elective Surgery

Intervention / Treatment
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* Drug: Dexmedetomidine
* Drug: Fentanyl


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA-I and ll patients Male and female patient of age 20-70 years. Undergoing Elective laparoscopic cholecystectomy. Exclusion Criteria: Pregnant and lactating females Short thick neck with anticipated difficult intubation. Obese patients. Narcotic addicts. Full stomach patient or with higher chances of aspiration. Patient allergic to any of the study medications. Patients high risk to develop serotonin syndrome. (patient taking an antidepressant and other psychomotor medications.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: RCT, Double-blind, Randomized control trial
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dex Group<br>intravenous dexmedetomidine 0.6mcg/kg in 100ml normal saline 0.9% | Drug: Dexmedetomidine<br>* intravenous dexmedetomidine 0.6mcg/kg in 100ml normal saline 0.9%<br>* Other names: Fentanyl;|
| Experimental: Fent Group<br>intravenous fentanyl at 2mcg/kg in 100ml saline | Drug: Fentanyl<br>* intravenous fentanyl at 2mcg/kg in 100ml saline<br>* Other names: Dexmedetomidine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Systolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at Baseline | 
| Systolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | 0 minute | 
| Systolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | 1 minute | 
| Systolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | 3 minute | 
| Systolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | 5 minute | 
| Systolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | 10 minute | 
| Diastolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at Baseline | 
| Diastolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | 0 minute | 
| Diastolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 1 minute | 
| Diastolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 3 minutes | 
| Diastolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 5 minutes | 
| Diastolic blood pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 10 minutes | 
| Heart rate | Hemodynamic response(induction) will be assessed on different point in time during procedure | at Baseline | 
| Heart rate | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 0 minute | 
| Heart rate | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 1 minute | 
| Heart rate | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 3 minutes | 
| Heart rate | Hemodynamic response(induction) will be assessed on different point in time during procedure | 5 minutes | 
| Heart rate | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 10 minutes | 
| Mean atrial pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at Baseline | 
| Mean atrial pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 0 minute | 
| Mean atrial pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 1 minute | 
| Mean atrial pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 3 minute | 
| Mean atrial pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 5 minute | 
| Mean atrial pressure | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 10 minute | 
| SpO (oxygen saturation) | Hemodynamic response(induction) will be assessed on different point in time during procedure | at Baseline | 
| SpO (oxygen saturation) | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 0 minute | 
| SpO (oxygen saturation) | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 1 minute | 
| SpO (oxygen saturation) | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 3 minute | 
| SpO (oxygen saturation) | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 5 minute | 
| SpO (oxygen saturation) | Hemodynamic response(induction) will be assessed on different point in time during procedure | at 10 minute | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ramsey score | Sedation scale with minimum score 1 indicate good response and maximum score 6 worst response | at arrival | 
| Ramsey score | Sedation scale with minimum score 1 indicate good response and maximum score 6 worst response | at 10 minutes | 
| Aldrete score | Post anesthesia Recovery assessment scale with minimum score 0 indicate worst response and maximum score 10 indicate excellent recovery | at arrival | 
| Aldrete score | Post anesthesia Recovery assessment scale with minimum score 0 indicate worst response and maximum score 10 indicate excellent recovery | at 10 min | 
| Complications | Post operative complication | Will be assessed within Hospital stay at follow for 1 week | 
| Laryngospasm | Post operative complication | Will be assessed within Hospital stay at follow for 1 week | 
| Bradycardia | Post operative complication | Will be assessed within Hospital stay at follow for 1 week | 
| Regurgitation | Post operative complication | Will be assessed within Hospital stay at follow for 1 week | 
| Post operative vomiting and nausea | Post operative complication | Will be assessed within Hospital stay at follow for 1 week | 
| Hypertension | Post operative complication | Will be assessed within Hospital stay at follow for 1 week | 
| Hypotension | Post operative complication | Will be assessed within Hospital stay at follow for 1 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Laparoscopic Cholecystectomy, Dexmedetomidine, Fentanyl, Hemodynamics response, Direct laryngoscopy, Intubation