Pregabalin premedication - A new treatment option for hemodynamic stability during general anesthesia: A prospective study

Abstract

Background:Hemodynamic responses of laryngoscopy, intubation, and pain are powerful noxious stimulus which should be attenuated by the appropriate premedication, smooth induction, and rapid intubation.Context:The oral pregabalin may attenuate the hemodynamic pressor response with intraoperative hemodynamic stability.Aims:The present study was designed to evaluate the clinical efficacy and safety of oral pregabalin for hemodynamic stability.Settings and Design:This is a prospective blind randomized controlled cohort observation study.Materials and Methods:The 80 adult consented patients of ASA grade I and II of either gender aged 24–54 years who met the inclusion criteria were randomized to receive oral pregabalin 150 mg or placebo capsule, given 60–75 min before surgery. Patients were premedicated with metoclopramide (10 mg), glycopyrrolate (0.2 mg), and fentanyl (1 μg/kg). Anesthesia was induced with propofol and rocuronium and maintained with isoflurane, nitrous oxide, and oxygen. Both groups were assessed for preoperative sedation and changes in heart rate and mean arterial blood pressure before and after the induction and 1, 3, 5, and 10 min after laryngoscopy and intubation, then at 5 min intervals till end of surgery along with postoperative complications.Statistical Analysis:The hemodynamic variables were analyzed by using analysis of variance (ANOVA), Student's t test, and chi square test as appropriate.Results:Preoperative sedation was higher with pregabalin with no significant change in heart rate. The mean arterial pressure was attenuated with oral pregabalin to statistically significant value (P<0.007). The requirement of analgesic drug was reduced with no postoperative respiratory depression, nausea, or vomiting and hemodynamic parameters remained stabilized perioperatively.Conclusions:Oral pregabalin premedication effectively leads to sedation and analgesia with successful attenuation of the adverse and deleterious hemodynamic pressor response.

Role of Preoperative Pregabalin in Reducing Inhalational Anaesthetic Requirements in Abdominal Hysterectomy: Randomized Controlled Trial

“…Single dose of oral pregabalin 150 mg was chosen, as it has been proven to be an optimal dose for postoperative pain management (1,15,16).Mishriky and colleagues reported in a systematic review that a single preoperative dose was as effective as multiple doses and all doses of pregabalin (75,100,150 and 300) resulted in opioid sparing effect. However, smaller doses (75,100 mg) were less effective and higher doses (300 mg) were limited by adverse effect; mainly dizziness and somnolence (7) Similar to that reported in previous studies in various patient populations undergoing different surgeries (17,18,19) pregabalin premedication resulted in intraoperative haemodynamic stability with suppression of the reflex tachycardia and hypertension related to intubation and extubation. The mechanism by which pregabalin attenuates haemodynamic pressor response to laryngoscopy and intubation is unknown, however, as a calcium channel modulator (3) it may be attributed to inhibition of calcium efflux from muscle cells (20) Pregabalin as a preventive analgesic that attenuates neuronal hyperexcitability and central sensitization (4) resulted in a remarkable pain relief with reduction of narcotic requirement in the immediate postoperative period.…”

Preoperative Sedation, Hemodynamic Stability during General Anesthesia and Improving Postoperative Pain: Pregabalin Is the Answer

“…However, the increase was the smallest with 150 mg of pregabalin. In contrast, Gupta et al found no significant difference in HR between the placebo group and the group administrated 150 mg of pregabalin; in addition, they found no statistically significant HR attenuation in the pregabalin premedicated groups, with a maximal increase in HR at 1 min after intubation and the smallest increase in pregabalin group, but this relation to group I was statistically insignificant [3].…”

“…Appropriate premedication, smooth induction and rapid intubation would prevent the associated risks and complications of the hemodynamic pressor responses, which may be attenuated pharmacologically. Various pharmacological techniques have been evaluated either as premedication or during induction to attenuate the adverse hemodynamic response to laryngoscopy and tracheal intubation, including deepening the anesthesia and, pretreatment with opioids, (beta) blockers, vasodilators and calcium channel blockers but with variable results [3].…”

Efficacy of pregabalin premedication prior to surgery in attenuating the adverse hemodynamic response to laryngoscopy and tracheal intubation

“…These findings were correlating well with the study done by Raichurkar et al and Gupta K et al where they inferred that mean arterial pressure was better attenuated with pregabalin. 7,11 Rate pressure product (RPP) is an indirect measure of myocardial oxygen consumption (MVO2). Myocardial oxygen consumption is correlated with the rate-pressure product (heart rate x systolic blood pressure) and this hemodynamic parameter has been shown to follow a circadian pattern similar to that observed with cardiovascular events.…”