Gabapentin pre-treatment for pressor response to direct laryngoscopy and tracheal intubation: a randomized, double-blind, placebo controlled study

Bhandari, Vikram; Dhasmana, D. C.; Dureja, Sheveta; Sharma, J. P.; Sachan, Praveendra Kumar; Chaturvedi, Aditi

doi:10.5455/2319-2003.ijbcp20141004

Cited by 5 publications

(10 citation statements)

References 6 publications

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“…[1-,3] Various agents, including anaesthetics, analgesics, adrenergic blocking agents and vasodilators effectively attenuate this response. [6][7][8][9][10][11][12] This has been a fertile area for clinical investigation, spawning numerous studies of the various techniques which might be expected to modify the haemodynamic response to intubation. Even a transient hyper-dynamic response may cause serious complication in patients with symptomatic aortic aneurysm, recent myocardial infarction, cerebral aneurysm, or intracranial hypertension, known or suspected ischaemic heart disease is by far the most common indication for modifying the haemodynamic response to intubation.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative myocardial ischaemia has been associated with postoperative myocardial infarction, and a causal relationship has been postulated. [8,10] Therefore, elimination of ischaemia at the time of intubation might prevent infarction. Modification of the haemodynamic response to intubaton is a laudable objective and is clearly indicated in a small subgroup of patients in whom a single hyper-dynamic episode may cause a catastrophe.…”

Section: Discussionmentioning

confidence: 99%

“…Omitting cholinergic premedication, pre-treatment with beta blockers, [6] calcium channel blockers, [7] nitroglycerine, [8] opioids, [9] gabapentin, [10] dexmedetomidine, [11] and clonidine [12] are common practices with variable results. Efficacy of oral pregabalin postoperative analgesia and reduction of parenteral analgesics has been demonstrated in several studies.…”

Section: Name and Address Of Corresponding Authormentioning

confidence: 99%

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Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study

2016

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Background: Laryngoscopy and intubation may cause undesirable increase in blood pressure and heart rate. The aim of the present study was to investigate the effect of Pregabalin premedication on hemodynamic responses to laryngoscopy and intubation. Methods: Sixty ASA physical status I or II patients undergoing elective surgery under general anesthesia were randomly allocated into two equal groups who received either oral Pregabalin 150 mg (Group PB)or placebo (Group PL)1 hour prior to surgery. Heart rate, Systolic, Diastolic and Mean arterial blood pressures were recorded preoperative, at laryngoscopy and 0,1,3,5 and 10 minutes after tracheal intubation. Results: Demographic data and base-line values for Heart rate, Systolic, Diastolic and Mean arterial blood pressures were comparable between groups. During laryngoscopy and intubation there was significant attenuation of SBP, DBP and MBP in PB group as compared to PL group. Although increase in heart rate was less in pregabalin group during laryngoscopy and intubation but it was not statistically significant. Conclusion:In the present study design, oral Pregabalin premedication at a dose of 150 mg one hour prior to surgery attenuates pressor response associated with laryngoscopy and endotracheal intubation but not the tachycardia significantly.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Name and Address Of Corresponding Authormentioning

confidence: 99%

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Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study

2016

AIMDR

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“…Geeta Bhandari et al 15 conducted a study on effect of gabapentin at a dose of 900 mg on pressor response to laryngoscopy and tracheal intubation when compared to placebo. They found that 0 min after intubation the mean diastolic blood pressure and heart rate were significantly less in the gabapentin group than the placebo group whereas there was no statistically significant difference in systolic blood pressure of both the group at o min after intubation was present.…”

Section: Dose Selectionmentioning

confidence: 99%

ATTENUATION OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY & INTUBATION- A COMPARATIVE STUDY BETWEEN ORAL GABAPENTIN AND ORAL CLONIDINE

Saikia¹,

Tayung²,

Saha³

2019

jemds

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BACKGROUND Laryngoscopy and endotracheal intubation are very essential tools in the hands of an anaesthesiologist in securing & maintaining the air way & administration of general anaesthesia. Direct laryngoscopy and endotracheal intubation are noxious stimuli that can lead to adverse response of cardiovascular, respiratory and other systems. Reid and Bruce, in the year 1904 & King Harris in 1951 described the circulatory response following laryngoscopy & tracheal intubation due to the stimulation of larynx and trachea as reflex sympatho-adrenal system. 1,2 METHODS 150 normotensive adult consenting patients aged 20-15 years, ASA grade 1 and grade 2 of both genders, were randomized into two treatment groups of 75 patients each. Group A patients received tablet of Gabapentin 900 mg and group B patients received tablet of Clonidine 200 micrograms, 120 minutes before surgery. 150 patients were randomly divided into two equal groups of 75 each namely group A and group B. Anaesthetic technique was standardized and all groups were assessed for haemodynamic changes before administration of study drug (t1), just before taking the patients in OT (t2), before intubation (t3), after intubation (t4), 0 minutes, 3 minutes, 5 minutes, 10 minutes, 30 minutes after intubation. RESULTS Significantly decreased heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and pulse pressure product were observed in both group A and group B, after laryngoscopy and intubation. CONCLUSIONS Gabapentin 900 mg attenuates the pressure response due to laryngoscopy and intubation better than Clonidine 200 mg. However, the attenuation of heart rate in both groups is similar.

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“…3). At five minutes, the analysis included 21 studies [21][22][23][24]26,[28][29][30][32][33][34][35][36][37][38][39]41,[43][44][45]47 with 1,350 participants where the aggregated effect estimate showed an attenuated rise with gabapentin (MD -9 mmHg; 95% CI, -13 to -5; low quality). At ten minutes, the analysis included 18 studies [21][22][23]26,28,30,[32][33][34][35][36][37][38][39]41,43,44,47 with 1,244 participants where the aggregated effect estimate showed an attenuated rise with gabapentin (MD, -8 mmHg; 95% CI, -11 to -5; low quality).…”

Section: Secondary Outcomesmentioning

confidence: 99%

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

Doleman

Sherwin

Lund

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Endotracheal intubation is the gold standard for securing the airway before surgery. Nevertheless, this procedure can produce an activation of the sympathetic nervous system and result in a hemodynamic response which, in high-risk patients, may lead to cardiovascular instability and myocardial ischemia. The aim of this review was to evaluate whether gabapentin can attenuate this response and whether such an attenuation could translate into reduced myocardial ischemia and mortality. Source We searched MEDLINE Ò , EMBASE TM , CINAHL, AMED, and unpublished clinical trial databases for randomized-controlled trials that compared gabapentin with control, fentanyl, clonidine, or beta blockers for attenuating the hemodynamic response to intubation. Primary outcomes were mortality, myocardial infarction, and myocardial ischemia. Secondary outcomes were hemodynamic changes following intubation. Principal findings We included 29 randomized trials with only two studies at low risk of bias. No data were provided for the primary outcomes and no studies included high-risk patients. The use of gabapentin resulted in attenuation in the rise in mean arterial blood pressure [mean difference (MD), -12 mmHg; 95% confidence interval (CI), -17 to -8] and heart rate (MD, -8 beatsÁmin -1 ; 95% CI, -11 to -5) one minute after intubation. Gabapentin also reduced the risk of hypertension or tachycardia requiring treatment (risk ratio, 0.15; 95% CI, 0.05 to 0.48). Data were limited on adverse hemodynamic events such as bradycardia and hypotension. Conclusion It remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations. RésuméObjectif L'intubation endotrachéale constitue l'étalon or de la prise en charge des voies aériennes avant une chirurgie. Toutefois, cette intervention peut entraîner une activation du système nerveux sympathique et provoquer une réponse hémodynamique qui, chez les patients courant un risque élevé, pourrait mener à une instabilité cardiovasculaire et une ischémie myocardique. L'objectif de ce compte rendu était d'examiner si la gabapentine pouvait atténuer cette réponse et si une telle atténuation pouvait se traduire en une réduction de l'ischémie myocardique et de la mortalité. Source Nous avons effectué des recherches dans les bases de données MEDLINE Ò , EMBASE TM , CINAHL, AMED, ainsi que dans les bases de données d'études cliniques non publiées afin d'en extraire les études randomisées contrô lées comparant la capacité de la gabapentine par rapport à un groupe témoin, au fentanyl, à la clonidine ou à des bêta-bloquants, à atténuer la réponse hémodynam...

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Gabapentin pre-treatment for pressor response to direct laryngoscopy and tracheal intubation: a randomized, double-blind, placebo controlled study

Cited by 5 publications

References 6 publications

Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study

Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study

ATTENUATION OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY & INTUBATION- A COMPARATIVE STUDY BETWEEN ORAL GABAPENTIN AND ORAL CLONIDINE

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

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