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 Source We searched MEDLINE Ò , EMBASE TM , CINAHL, AMED, and unpublished clinical trial databases for randomized-controlled trials that compared gabapentin with control, fentanyl, clonidine, or beta blockers for attenuating the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...