A Comparison of Perioperative Hemodynamic Stability with Amlodipine and Telmisartan during Laparoscopic Cholecystectomy in known Hypertensive Patients:

Mandeep Manohar Harison Madia; Atul Kumar Singh; Subhdeep Manohar Wrangler Richi; Ram Badan Singh

doi:10.21276/ajmr.2019.8.2.AN2

Mandeep Manohar Harison Madia Junior Resident, Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi
Atul Kumar Singh Assistant Professor, Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi
Subhdeep Manohar Wrangler Richi Senior Resident, Department of Anaesthesiology, Rajkiye Medical College, Orai
Ram Badan Singh Professor, Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi

DOI: https://doi.org/10.21276/ajmr.2019.8.2.AN2

Keywords: Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure, Brain Natriuretic Peptide, Amlodipine, Telmisartan

Abstract

Background: There are many antihypertensive agents available for optimal control of elevated blood pressure. The agent with better safety profile and minimal side effects are the agents of choice. The aim of this study is to compare the perioperative hemodynamics stability with Amlodipine and Telmisartan during laparoscopic cholecystectomy in known hypertensive patients. Subjects and Methods: A comparative, prospective, randomized interventional study was conducted in 60 known hypertensive patients of either sex of ASA PS II and III class, aged 40-70 years undergoing laparoscopic cholecystectomy. Patients were randomly allocated to Group A: taking Amlodipine 5 mg once daily, and Group B: taking Telmisartan 40 mg once daily. Hemodynamic monitoring was done including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure and brain natriuretic peptide (BNP) as cardiac marker. Results: Among the hemodynamic variables there was significant difference (p-value<0.05) in heart rate, mean arterial pressure, brain natriuretic peptide. Heart rate, mean arterial pressure was better controlled in patients receiving Telmisartan. Rise in BNP level was significantly less during intraoperative period in patients receiving Telmisartan. HR, SBP, DBP and demographic profile were comparable between two groups. Conclusion: One of the major responsibility of anaesthesiologist is to maintain hemodynamic stability during intra-operative and post-operative period. Hemodynamic stability if not managed successfully particularly in hypertensive patients can lead to poor outcomes during intra-operative and post-operative period. Antihypertensive medications are administered for at least 1-2 weeks for returning of normal autoregulation and optimum blood pressure control. Telmisartan has better control over blood pressure in comparison to amlodipine.

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