Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study

Kumar, Rakesh; Kumari, Kamlesh; Janweja, Sarita; Verma, Manoj Kumar; Sharma, Ankur; Paliwal, Bharat; Kishan, Rama

doi:10.1016/j.bjane.2021.08.011

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…Many studies have shown melatonin premedication to result in reduction of induction dose of propofol with attenuation of hemodynamic responses to intubation. [ 9 10 11 12 13 ]Though we observed reduced requirement of propofol, blunted stress response to intubation was not seen in our study. Sublingually administered melatonin 3 mg, given 50 minutes before surgery to achieve a bi-spectral index of 40 has shown to reduce propofol dose significantly as compared to placebo (49.88 ± 14.48 vs 77.38 ± 23.56mg, P = 0.002).…”

Section: Discussioncontrasting

confidence: 63%

“…The use of a lower dose of propofol compared to the study by Kumar et al . [ 12 ] could be the reason for the conflicting observations made in our study. They observed reduced intraoperative requirement of fentanyl while we did not observe that.…”

Section: Discussionmentioning

confidence: 54%

“…However, in a study by Kumar et al . [ 12 ] with a similar methodology, the authors concluded that melatonin premedication resulted in significant attenuation of postintubation rise in HR and MAP with reduced induction dose of propofol and total intraoperative fentanyl consumption. In their study, the mean induction dose of propofol in the melatonin and placebo groups were 74.21 ± 12.483 mg and 118.00 ± 16.361 mg, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial

Rajan,

Abubaker,

Kala

et al. 2023

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Sedative effects of melatonin may have an additive effect on general anesthesia (GA). We compared hemodynamic response to intubation following oral premedication with melatonin versus placebo. Induction dose of propofol, isoflurane and fentanyl consumption were also compared. Material and Methods: This prospective, double-blinded study was conducted in fifty patients randomized into two equal groups. Group M received oral melatonin 6 mg and group P a placebo two hours before surgery. All patients were induced with intravenous propofol of 1.5–2.5mg/kg till loss of response to verbal commands, three minutes after vecuronium, laryngoscopy was done and trachea was intubated. Heart rate (HR) and mean arterial pressures (MAP) were recorded before premedication, before induction, immediately after induction and then at 1,3,5 and 10 minutes after intubation. Results: Mean HR was comparable in both groups throughout the study period. Group M had significantly lower MAP before induction and immediately after induction (P < 0.05). At all other time points MAP remained comparable in both groups. Mean isoflurane consumption was significantly lower in group M compared to group P (14.8 ± 4.2 vs 19.7 ± 3.2 mL). Propofol requirement for induction was also significantly lower in group M (102.4 ± 19.6 vs 122.4 ± 26.3mg). Intraoperative fentanyl consumption was comparable. Conclusion: Oral premedication with melatonin 6mg administered two hours before surgery significantly reduced MAP before and after induction of GA with a significant reduction in dose of propofol requirement.Titrating induction dose of propofol till loss of response to verbal commands did not effectively attenuate responses to laryngoscopy and intubation following melatonin oral premedication.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial

Rajan,

Abubaker,

Kala

et al. 2023

Journal of Anaesthesiology Clinical Pharmacology

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“…Others have observed that there was a 10.59% and 37.08% rise in HR at 1 minute respectively in 6 mg melatonin group compared to placebo group. Maximum percentage increase in SBP, DBP, and MBP was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. [14] 35.51%, MBP 9.99% vs. 36.45% at 1 minute post intubation. [15] In a study comparing melatonin 6 mg and clonidine 0.2 mg [16] or 0.1mg it was observed that oral melatonin is superior to oral clonidine in attenuating hemodynamic response to laryngoscopy and tracheal intubation.When melatonin 6 mg was compared with pregabalin 150 mg and placebo, it was observed that melatonin 6mg was more effective in attenuating hemodynamic responses than that of the [17] pregabalin 150 mg and placebo.…”

Section: Discussionmentioning

confidence: 99%

Effect of Different Doses of Oral Melatonin as a Premedication for Attenuation of Intubation Response

B Muniyappa,

Salim Iqbal,

Varghese

et al. 2023

PIJR

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Background And Aims: Airway manipulation during laryngoscopy and tracheal intubation acts as a powerful noxious stimuli leading to adverse cardiovascular responses, especially in patients with hypertension, coronary artery diseases etc. Melatonin is an endogenous sleep-regulating hormone exhibiting inhibitory actions on central nervous system, may also have role in attenuating hemodynamic responses to laryngoscopy and intubation. We hypothesized that, melatonin 9 mg is better than 6 mg in attenuating intubation response to laryngoscopy and endotracheal intubation. Material And Methods: The randomized control study was conducted on 80 patients scheduled to undergo elective surgeries under general anesthesia with endotracheal intubation. Group A received oral melatonin 6 mg and group B received 9 mg melatonin, 120 minutes before surgery. Hemodynamic parameters were recorded at baseline, 30, 60, 120 minutes after drug administration, pre-induction, post induction and every minute after intubation till 5 minutes then at 10th minute. Sedation scores were assessed using Ramsay sedation scores. Results: In group A, baseline mean HR was 84.78 ± 9.59 beats per minute (95% CI:65.6 - 103.96) and postintubation at 1minute it was 88.25 ± 13.68 bpm (95% CI:60.89 -115.61). In group B, baseline mean HR was 83.27 ± 14.84bpm (95% CI:59.81-108.09) and postintubation at 1minute it was 83.28 ± 14.84 bpm (95% CI:53.6 - 112.96).In group A,baseline mean MAP was 95.07 ± 9.05 mmHg (95% CI:76.98 - 113.18) and postintubation at 1minute it was 87.88 ± 14.89mmHg (95% CI:58.1 - 117.66).In group B, baseline mean MAP was 95.15 ± 10.54 mmHg (95% CI:74.07 - 116.23) and postintubation at 1minute it was 88.35 ± 15.67 mmHg (95% CI:57.01 - 119.69). Pressor response to tracheal intubation was attenuated in both groups and no statistical significance was noted between two groups.Both groups had sedation scores of 2-3.Conclusion: Both oral melatonin 6 mg and 9 mg when administered 120 minutes before induction of anaesthesia were effective in attenuating the hemodynamic responses to laryngoscopy and intubation.

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“…Serum melatonin was proportional to sublingual melatonin that was administered in the afternoon. More recently, Kumar and collaborators [93] showed that preanesthetic oral melatonin attenuates anesthetic requirement and hemodynamic responses to intubation. The melatonin group significantly reduced the induction dose of propofol and the number of patients requiring additional fentanyl intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Possible Role of Pineal and Extra-Pineal Melatonin in Surveillance, Immunity, and First-Line Defense

Markus

Sousa

Cruz‐Machado

et al. 2021

IJMS

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Melatonin is a highly conserved molecule found in prokaryotes and eukaryotes that acts as the darkness hormone, translating environmental lighting to the whole body, and as a moderator of innate and acquired defense, migration, and cell proliferation processes. This review evaluates the importance of pineal activity in monitoring PAMPs and DAMPs and in mounting an inflammatory response or innate immune response. Activation of the immune–pineal axis, which coordinates the pro-and anti-inflammatory phases of an innate immune response, is described. PAMPs and DAMPs promote the immediate suppression of melatonin production by the pineal gland, which allows leukocyte migration. Monocyte-derived macrophages, important phagocytes of microbes, and cellular debris produce melatonin locally and thereby initiate the anti-inflammatory phase of the acute inflammatory response. The role of locally produced melatonin in organs that directly contact the external environment, such as the skin and the gastrointestinal and respiratory tracts, is also discussed. In this context, as resident macrophages are self-renewing cells, we explore evidence indicating that, besides avoiding overreaction of the immune system, extra-pineal melatonin has a fundamental role in the homeostasis of organs and tissues.

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Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study

Cited by 5 publications

References 21 publications

Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial

Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial

Effect of Different Doses of Oral Melatonin as a Premedication for Attenuation of Intubation Response

Possible Role of Pineal and Extra-Pineal Melatonin in Surveillance, Immunity, and First-Line Defense

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