Original Research Article DOI: 10.18231/2394-4994.2018.0110 Indian Journal of Clinical Anaesthesia, October-December, 2018;5(4):582-590 582 Effect of dexmedetomidine infusion on stress induced blood glucose levels and intraoperative sevoflurane requirement Yasha V Kameshwar 1,* , M R Upadhyay 2 1 Ex-Student, 2 Professor and HOD, Dept. of Anaesthesiology, SSG Hospital and Baroda Medical College, Vadodara, Gujarat, India *Corresponding Author: Yasha V Kameshwar Email: yasha.vdk@gmail.com Received: 14 th September, 2018 Accepted: 3 rd November, 2018 Abstract Introduction: Dexmedetomidine has been shown to blunt the stress response to surgery and reduce the consumption of inhalational anaesthetic agents. Hence, we designed this study to observe the effects of IV Dexmedetomidine infusion on stress- induced blood glucose levels and intra operative Sevoflurane requirement during laparoscopic surgery. Materials and Methods: Sixty patients between the ages of 18-60 years, of either gender, ASA Grade I & II, posted for elective laparoscopic surgical procedures under general anaesthesia were divided into two groups of 30 each. Group D received loading dose of Inj. Dexmedetomidine at 1μg/kg diluted to 50 ml and given over 10 minutes; followed by maintenance with 0.5μg/kg/hour, till the end of surgery. Group P received similar volume of normal saline. Anaesthesia was maintained with Nitrous oxide in oxygen (50:50) and Sevoflurane keeping BIS 40 - 60. Serial blood glucose levels, sevoflurane requirement by Dion’s method, extubation time, sedation score and adverse effects were observed. The data was analyzed using student t test. Results: Blood glucose levels at first hour post operatively in group P and in group D, were 136.7±6.30 mg/dl and 103.8±8.28 mg/dl respectively (P<0.0001). There was 27.07% rise in group P and 2.89% fall in group D from baseline value. Mean first hourly Sevoflurane consumption in group P and in group D were 11.22±1.14 ml and 8.34±0.88 ml respectively (p<0.0001) (25.61% reduction in group D). Conclusion: IV Dexmedetomidine infusion was effective in attenuating stress induced blood glucose levels and it also reduced Sevoflurane requirement without affecting the time for extubation. Keywords: Dexmedetomidine, Stress induced blood glucose levels, Dion’s method, Sevoflurane consumption. Introduction Alpha (α)-2 adrenergic receptor (AR) agonists are the centre of interest in Anaesthesiology since last two decades for their sedative, anxiolytic, analgesic and sympatholytic properties. 1,2 The first member of this group; Clonidine; which was introduced in 1960 as nasal decongestant, was later used as an adjuvant for general as well as regional anaesthesia. 1,2 After the discovery of Clonidine, a more potent Alpha(α) -2 agonist Medetomidine; 3 and its stereoisomer Dexmedetomidine were discovered. Dexmedetomidine has been described as a ‘Wonder Drug’ 4 due to its multiple roles in anaesthesia practise. Stress response to surgery and anaesthesia is not only manifested as changes in pulse rate and blood pressure but also by metabolic, neurohormonal and immunological changes. 5,6 Therefore, various indicators like blood glucose, serum cortisol, Interleukin-6, plasma nor-epinephrine levels have been used to quantify the stress response and their attenuation by dexmedetomidine has been demonstrated. 7,8 In addition to its analgesia sparing property; 9,10 intravenous administration of Dexmedetomidine during general anaesthesia is reported to decrease the minimum alveolar concentration (MAC) and intraoperative requirement of volatile anaesthetic agents. 11 This clinical study; therefore, aims to demonstrate the effect of intravenous Dexmedetomidine administration on stress induced blood glucose levels and intra operative Sevoflurane requirement. It also includes assessment of perioperative hemodynamic stability, time for tracheal extubation and post operative sedation levels. Materials and Methods After obtaining institutional ethical and scientific research committee approval; this prospective, randomised, single blind, placebo-controlled clinical trial was conducted in department of Anaesthesiology, Government Medical College and SSG Hospital Vadodara during November 2014 to November 2015. 60 patients of age group 18 to 60 years, of either gender, American Society of Anaesthesiologists (ASA) grade I and II, posted for laparoscopic intra-peritoneal surgeries of 1-2 hours duration with minimal expected blood loss were enrolled. Patients on α-2 agonists or antagonists, β blockers, calcium channel blockers, digoxin or any other anti hypertensive agent, psycho active medications, pregnant and breast feeding mothers, ASA grade III or IV patients and those unwilling to participate in the study were excluded. After thorough pre anaesthetic check up and routine investigations, selected patients were informed about the motto of our study in local language and a written