Journal of Mahatma Gandhi University of Medical Sciences and Technology

Register      Login

VOLUME 2 , ISSUE 3 ( 2017 ) > List of Articles


A Comparison of the Effect of Dexmedetomidine and Esmolol in Attenuating Stress Responses during Laparoscopic Surgeries

Manisha Agrawal, Durga Jethava, DD Jethava

Keywords : Dexmedetomidine, Esmolol, Laparoscopic, Pneumoperitoneum

Citation Information : Agrawal M, Jethava D, Jethava D. A Comparison of the Effect of Dexmedetomidine and Esmolol in Attenuating Stress Responses during Laparoscopic Surgeries. J Mahatma Gandhi Univ Med Sci Tech 2017; 2 (3):151-156.

DOI: 10.5005/jp-journals-10057-0056

License: CC BY-NC-ND 3.0

Published Online: 01-08-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Introduction The creation of pneumoperitoneum leads to increased mean arterial pressure and systemic vascular resistance as a result of stimulation of the sympathetic system leading to increased release of catecholamines and vasopressin. In order to prevent these hemodynamic changes, various pharmacological agents like clonidine, esmolol, or dexmedetomidine are used. Hence, there is need for this study. Materials and methods A total of 60 patients were randomized into two equal groups: group D—dexmedetomidine was administered as loading dose 1 µg/kg administered slowly over 15 minutes before induction followed by maintenance infusion of 0.5 µg/kg/hour throughout the period of pneumoperitoneum. Group E—esmolol was administered as loading dose at 1 mg/kg administered slowly over 5 minutes before induction followed by maintenance infusion of 0.5 mg/kg/hour throughout the period of pneumoperitoneum. Intra-abdominal pressure was maintained at 12 to 14 mm Hg throughout the procedure. The infusions were discontinued immediately after the release of pneumoperitoneum. Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at frequent intervals as per the pro forma. Data were analyzed using appropriate statistical tests. Results and conclusions As compared with esmolol, dexmedetomidine is more effective for attenuation of the pressor responses to pneumoperitoneum and thus achieving hemodynamic stability during laparoscopic surgeries (p < 0.05). How to cite this article Gupta P, Agrawal M, Jethava D, Jethava DD. A Comparison of the Effect of Dexmedetomidine and Esmolol in Attenuating Stress Responses during Laparoscopic Surgeries. J Mahatma Gandhi Univ Med Sci Tech 2017;2(3):151-156.

PDF Share
  1. Das M, Ray M, Mukherjee G. Hemodynamic changes during laparoscopic cholecystectomy: effect of clonidine premedication. Indian J Anaesth 2007 Mar;51(3):205-210.
  2. Mishra M, Mishra SP, Mathur SK. Clonidine versus nitroglycerin infusion in laparoscopic cholecystectomy. JSLS 2014 Jul-Sep;18(3):e2014.00305.
  3. Shah P, Patel H, d'souza R, Shukla S, Rupakar V. A comparison of fentanyl, esmolol and their combination for attenuation of hemodynamic response to laryngoscopy and tracheal intubation. IJSRP 2014 Dec;12(4):1-6.
  4. Khanduja S, Ohri A, Panwar M. Dexmedetomidine decreases requirement of thiopentone sodium and pentazocine followed with improved recovery in patients undergoing laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2014 Apr;30(2):208-211.
  5. Laxmi Narsaiah G, Murali CH, Rao BS, Kumar DP, Kumar GS. Hemodynamic effects of low dose dexmedetomidine infusion in patients undergoing laparoscopic cholecystectomy—a randomized study. Sch J App Med Sci 2016 May;4(5D):1736-1740.
  6. Harless M, Depp C, Collins S, Hewer I. Role of esmolol in perioperative analgesia and anesthesia. AANA J 2015 Jun;83(3):167-177.
  7. Srivastava VK, Nagle V, Agrawal S, Kumar D, Verma A, Kedia S. Comparative evaluation of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy. J Clin Diagn Res 2015 Mar;9(3):UC01-UC05.
  8. Bayram A, Ülgey A, Günes I, Ketenci I, Capar A, Esmaoğlu A, Boyacı A. Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery. Rev Bras Anesthesiol 2015 Jan-Feb;65(1):61-67.
  9. Nazir O, Wani MA, Ali N, Sharma T, Khatuja A, Misra R, Maqsood M. Use of dexmedetomidine and esmolol for hypotension in lumbar spine surgery. Trauma Mon 2016 Jul;21(3):e22078.
  10. Ozturk T, Kaya H, Aran G, Aksun M, Savaci S. Postoperative beneficial effects of esmolol in treated hypertensive patients undergoing laparoscopic cholecystectomy. Br J Anaesth 2008 Feb;100(2):211-214.
  11. Aho M, Scheinin M, Lehtinen AM, Erkola O, Vuorinen J, Korttila K. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg 1992 Dec;75(6):932-939.
  12. Bhattacharjee DP, Nayak SK, Dawn S, Bandopadhyay G, Gupta K. Effects of dexmedetomidine on hemodynamics in patients undergoing laparoscopic cholecystectomy: a comparative study. J Anaesth Pharmacol 2010 Jan;26(1):45-48.
  13. Koivusalo AM, Scheinin M, Tikkanen I, Yli-Suomu T, Ristkari S, Laakso J, Lindgren L. Effects of esmolol on hemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery. Acta Anaesthesiol Scand 1998 May;42(5):510-517.
  14. Priya V, Malviya PS, Mishra LS. Comparative evaluation of attenuation of postextubation hyperdynamic responses with single dose dexmedetomidine or esmolol: a double blind, randomized, controlled trial. Asian Arch Anaesth Resuscitation 2012 Apr-Jun;74(2):2199-2205.
  15. Shams T, El Bahnasawe NS, Abu-Samra M, El-Masry R. Induced hypotension for functional endoscopic sinus surgery: a comparative study of dexmedetomidine versus esmolol. Saudi J Anaesth 2013 Apr;7(2):175-180.
  16. Bhattacharjee DP, Saha S, Paul S, Roychowdhary S, Mondal S, Paul S. A comparative study of esmolol and dexmedetomidine on hemodynamic responses to carbon dioxide pneumoperitoneum during laparoscopic surgery. Anesth Essays Res 2016 Sep-Dec;10(3):580-584.
  17. Kotak N, Patil N, Rathod Y. Attenuation of intraoperative pressure response to pneumoperitoneum in patients undergoing laparoscopic cholecystectomy—a comparative study between dexmedetomidine and esmolol. IOSR J Dent Med Sci 2016 Feb;15(2):85-95.
  18. Schiller E. Early childhood caries: prevention through knowledge. OHDMBSC 2006 Sep;5(3):3-5.
  19. Dagdeviren H, Cengiz H, Heydarova U, Caypinar SS, Kanawati A, Guven E, Ekin M. Intramuscular versus intravenous prophylactic oxytocin for postpartum hemorrhage after vaginal delivery: a randomized controlled study. Arch Gynecol Obstet 2016 Nov;294(5):911-916.
  20. Vendittelli F, Barasinski C, Pereira B, Dreyfus M, Lémery D, Bouvier-Colle MH; HERA Group. Policies for management of postpartum haemorrhage: the HERA cross-sectional study in France. Eur J Obstet Gynecol Reprod Biol 2016 Oct;205:21-26.
  21. Springhall E, Wallace EM, Stewart L, Knight M, Mockler JC, Davies-Tuck M. Customised management of the third stage of labour. Aust N Z J Obstet Gynaecol 2017 Jun;57(3):302-307.
  22. Chaudhuri P, Majumdar A. A randomized trial of sublingual misoprostol to augment routine third-stage management among women at risk of postpartum hemorrhage. Int J Gynaecol Obstet 2016 Feb;132(2):191-195.
  23. Schack SM, Elyas A, Brew G, Pettersson KO. Experiencing challenges when implementing active management of third stage of labor (AMTSL): a qualitative study with midwives in Accra, Ghana. BMC Pregnancy Childbirth 2014 Jun;14:193.
  24. Gulmezoglu AM, Lumbiganon P, Landoulsi S, Widmer M, Abdel-Aleem H, Festin M, Carroli G, Qureshi Z, Souza JP, Bergel E, et al. Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, non-inferiority trial. Lancet 2012 May;379(9827):1721-1727.
  25. Althabe F, Alemán A, Tomasso G, Gibbons L, Vitureira G, Belizan JM, Buekens P. A pilot randomized controlled trial of controlled cord traction to reduce postpartum blood loss. Int J Gynaecol Obstet 2009 Oct;107(1):4-7.
  26. Gambheera H, Williams S. Shared challenges in psychiatric research in India and Sri Lanka. Indian J Psychiatry 2010 Jan;52(Suppl 1):S80-S82.
  27. Mallick N, Ray S, Mukhopadhyay S. Eating behaviors and body weight concerns among adolescent girls. Adv Public Health 2014 Jul;2014:257396.
  28. Witcomb GL, Arcelus J, Chen J. Can cognitive dissonance methods developed in the West for combatting the ‘thin ideal’ help slow the rapidly increasing prevalence of eating disorders in non-Western cultures? Shanghai Arch Psychiatry 2013 Dec;25(6):332-340.
  29. Rosenblum GD, Lewis M. The relations among body image, physical attractiveness, and body mass in adolescence. Child Dev 1999 Jan-Feb;70(1):50-64.
  30. Rodriguez R, Marchand E, Ng J, Stice E. Effects of a cognitive dissonance-based eating disorder prevention program are similar for Asian American, Hispanic, and White participants. Int J Eat Disord 2008 Nov;41(7):618-625.
  31. Crandall, R.; Reser, A. Attributions and weight-based prejudice. In: Brownell K, Puhl R, Schwartz M, Rudd L, editors. Weight bias: nature, consequences and remedies. New York: Guildford Press; 2005. pp. 83-96.
  32. Khan AN, Khalid S, Khan HI, Jabeen M. Impact of today's media on university student's body image in Pakistan: a conservative, developing country's perspective. BMC Public Health 2011 May;11:379.
  33. Calado M, Lameiras M, Sepulveda AR, Rodríguez Y, Carrera MV. The mass media exposure and disordered eating behaviours in Spanish secondary students. Eur Eat Disord Rev 2010 Sep-Oct;18(5):417-427.
  34. Rodgers R, Chabrol H. The impact of exposure to images of idealized thin models on body dissatisfaction in young French and Italian women. Encephale 2009 Jun;35(3):262-268.
  35. Blond A. Impacts of exposure to images of ideal bodies on male body dissatisfaction: a review. Body Image 2008 Sep;5(3):244-250.
  36. Morris AM, Katzman DK. The impact of the media on eating disorders in children and adolescents. Paediatr Child Health 2003 May;8(5):287-289.
  37. Grilo CM, Masheb RM, Brody M, Burke-Martindale CH, Rothschild BS. Binge eating and self-esteem predict body image dissatisfaction among obese men and women seeking bariatric surgery. Int J Eat Disord 2005 May;37(4):347-351.
  38. Daniali S, Azadbakht L, Mostafavi F. Relationship between body satisfaction with self esteem and unhealthy body weight management. J Educ Health Promot 2013 Jul;2:29.
  39. Huang JS, Norman GJ, Zabinski MF, Calfas K, Patrick K. Body image and self-esteem among adolescents undergoing an intervention targeting dietary and physical activity behaviors. J Adolesc Health 2007 Mar;40(3):245-251.
  40. Wang, Y.; Wu, Y.; Wilson, RF.; Bleich, S.; Cheskin, L.; Weston, C.; Showell, N.; Fawole, O.; Lau, B.; Segal, J. Childhood obesity prevention programs: comparative effectiveness review and meta-analysis. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013. [cited 2013 Jun]. Available from:
  41. Khan MA, Mahomed MF, Ashshi AM, Faiz A. Drug resistance patterns of Acinetobacter baumannii in Makkah, Saudi Arabia. Pak J Med Res 2012 Oct-Dec;51(4):127-131.
  42. Shields RK, Clancy CJ, Gillis LM, Kwak EJ, Silveira FP, Massih RC, Eschenauer GA, Potoski BA, Nguyen MH. Epidemiology, clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients. PLoS One 2012 Dec;7(12):e52349.
  43. Prashanth K, Badrinath S. In vitro susceptibility pattern of Acinetobacter species to commonly used cephalosporins, quinolones and aminoglycosides. Indian J Med Microbiol 2004 Apr-Jun;22(2):97-103.
  44. Armin S, Karimi A, Fallah F, Tabatabaii RS, Alfatemi SM, Khiabanirad P, Shiva F, Fahimzad A, Rahbar M, Mansoorghanaii R, et al Antimicrobial resistance pattern of Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus isolated from patients with nosocomial infection admitted to Tehran hospitals. Arch Pediatr Infect Dis 2015 Oct;3(4):e32554.
  45. Qureshi ZA, Abbasi SA, Mirza IA, Malik N, Amjad A, Sattar A, Ikram A. Antimicrobial susceptibility pattern of Acinetobacter species-one year experience in a tertiary care setting. Infect Dis J 2011 Mar;20(1):269-272.
  46. Spencer L, Bubner T, Bain E, Middleton P. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Cochrane Database Syst Rev 2015 Sep;9:CD011263.
  47. Li M, Yao Q, Xing A. A clinical analysis of 188 cases of pregnancy complicated with critical heart disease. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014 Nov;39(11):1145-1150.
  48. Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, Talwar KK. Cardiac disease in pregnancy. Int J Gynaecol Obstet 2003 Aug;82(2):153-159.
  49. Gelson E, Curry R, Gatzoulis MA, Swan L, Lupton M, Steer P, Johnson M. Effect of maternal heart disease on fetal growth. Obstet Gynecol 2011 Apr;117(4):886-891.
  50. Arora N, Kausar H, Jana N, Mandal S, Mukherjee D, Mukherjee R. Congenital heart disease in pregnancy in a low-income country. Int J Gynaecol Obstet 2015 Jan;128(1):30-32.
  51. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000 Jul;183(1):S1-S22.
  52. Agency for Healthcare Research and Quality. Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment no.14. AHRQ publication no. 00-E011. Rockville, MD: Agency for Healthcare Research and Quality; 2000.
  53. Ferrer RL, Sibai BM, Mulrow CD, Chiquette E, Stevens KR, Cornell J. Management of mild chronic hypertension during pregnancy: a review. Obstet Gynecol 2000 Nov;96(5 Pt 2):849-860.
  54. Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia 1999 May;40(5):631-636.
  55. Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, McCorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet 2015 Nov;386(10006):1845-1852.
  56. Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 2010 Nov;5(11):2060-2068.
  57. Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, Louis E, Masson P, De Keyser F. Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use. Rheumatology (Oxford) 2011 Nov;50(11):1955-1968.
  58. Velu PP, Gravett CA, Roberts TK, Wagner TA, Zhang JS, Rubens CE, Gravett MG, Campbell H, Rudan I. Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries. J Glob Health 2011 Dec;1(2):171-188.
  59. UNAIDS: UNAIDS report on the global AIDS epidemic. 2010. Available from
  60. Ioannidis JP, Abrams EJ, Ammann A, Bulterys M, Goedert JJ, Gray L, Korber BT, Mayaux MJ, Mofenson LM, Newell ML, et al. Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J Infect Dis 2001 Feb;183(4):539-545.
  61. Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev 2013 Apr;4:CD009153.
  62. Rimoin DL, Connor JM, Pyeritz RE, Korf BR. Emery and Rimoin's principles and practice of medical genetics. Churchill Livingstone Elsevier; 2007.
  63. Verma IC, Puri RD. Global burden of genetic disease and the role of genetic screening. Semin Fetal Neonatal Med 2015 Oct;20(5):354-363.
  64. White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM. Measles, mumps, and rubella. Clin Obstet Gynecol 2012 Jun;55(2):550-559.
  65. American College of Obstetricians and Gynecologists. ACOG educational bulletin: viral hepatitis in pregnancy. Int J Gynaecol Obstet 1998 Nov;63:195-202.
  66. Geeta MG, Riyaz A. Prevention of mother to child transmission of hepatitis B infection. Indian Pediatr 2013;50:189-192.
  67. Swamy GK, Beigi RH. Maternal benefits of immunization during pregnancy. Vaccine 2015 Nov;33(47):6436-6440.
  68. Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, et al. Association of Tdap vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations. JAMA 2015 Oct;314(15):1581-1587.
  69. Singru SA, Tilak VW, Gandham N, Bhawalkar JS, Jadhav SL, Pandve HT. Study of susceptibility towards Varicella by screening for the presence of IgG antibodies among nursing and medical students of a Tertiary Care Teaching Hospital in Pune, India. J Glob Infect Dis 2011 Jan-Mar;3(1):37-41.
  70. Nathwani D, Maclean A, Conway S, Carrington D. Varicella infections in pregnancy and the newborn. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998;36 (Suppl 1):59-71.
  71. Michaan N, Amzallag S, Laskov I, Cohen Y, Fried M, Lessing JB, Many A. Maternal and neonatal outcome of pregnant women infected with H1N1 influenza virus (swine flu). J Matern Fetal Neonatal Med 2012 Feb;25(2):130-132.
  72. Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006 Jul;55(RR-10):1-42.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.