Use of Gabapentin, Esmolol or Their Combination to Attenuate Haemodynamic Response to Laryngoscopy and Intubation

Shrestha, Gentle S; Marhatta, Moda Nath; Amatya, Roshana

doi:10.3126/kumj.v9i4.6336

Cited by 11 publications

(14 citation statements)

References 35 publications

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“…In the study by Iftikhar they reported a significant difference for heart rate in Gabapentin and placebo group. 20 There is yet an undocumented but strong observation that population in our part of the world is very sensitive to the sedative effects of gabapentin. It is worthwhile noting that studies by Shirpa, Fassoulaki and Tahera exclude nasotracheal intubation in patients undergoing oral and maxillofacial surgeries and it appears that pre-operative gabapentin blunts the heamodynamic response to nasotracheal intubation as well as in endotracheal intubation.…”

Section: Resultsmentioning

confidence: 99%

Gabapentin

Boota

Nasir

Hyder

2018

TPMJ

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Introduction: There have been several methods used to prevent or attenuate the adverse hemodynamic changes following endotracheal intubation, but not many studies have been done for the same purpose in patients undergoing nasotracheal intubation. Deepening of anaesthesia, omitting cholinergic premedication, pre-treatment with vasodilators such as nitroglycerine, beta blockers, calcium channel blockers and opioids are few of the different techniques used when trachea is intubated orally or nasally, to blunt significant swings in hemodynamic parameters. We assessed the effectiveness of oral gabapentin to determine changes in hemodynamic response in normotensive patients following nasotracheal intubationwith or without laryngoscopy for elective maxillofacial surgeries. Study Design: Randomized double blind, placebo-controlled clinical trial. Setting: Department of Anesthesia & Intensive Care, Fauji Foundation Hospital Rawalpindi. Period: 18 months after approval from the ethical committee. Material & Methods: Total 130 patients were included in the study. These patients were randomly divided into 2 groups. In Group-A patients were given 800 mg gabapentin and in Group-B patients were given placebo. Heart rate and mean arterial pressures were recorded just before intubation as base line values, and then average readings were taken at 1 minute, 3 minutes, 5 minutes and 10 minutes after intubation. Bradycardia and hypotension were adequately treated with intravenous atropine and vasopressors. Data entry and analysis was done by using SPSS 17. Results: Total 130 patients who underwent elective surgeries were included in the study and divided into 2 groups each group containing 65 patients each. At 1st minute MAP in Group-A (oral gabapentin) and in Group-B (Placebo) was 86.89±4.36 and 98.70±4.39. At 3rd minute MAP in Group-A, in Group-B was 83.40±4.05 and 92.93±4.79. At 5th minute MAP was 82.50±5.00 and 88.03±4.22 and lastly at 10th minute MAP was 79.81±5.37 in Group-A and 83.18±4.77 in Group-B respectively. P-value at 1st, 3rd, 5th and at 10th minutes showed that statistically MAP was different in both treatment groups at the above mentioned time intervals. 1st minute: p-value=0.042, 3rd minute: p-value=0.000, 5th minute: p-value=0.000 and at 10th minute: p-value=0.000. At 1st minute heart rate in Group-A and Group-B was 87.89±1.39 and 93.47±6.88 respectively. At 3rd minute heart rate in Group-A and Group-B was 83.47±5.47 and 89.70±6.76. At 5th minute heart rate was 82.10±5.01 and 84.60±5.91 and lastly at 10th minute heart rate was 78.09±6.79 in Group-A and 77.27±5.34 in Group-B respectively. P -value at 1st, 3rd and 5th minutes showed that statistically heart rate was different in both treatment groups at the above mentioned time intervals. But at 10th minute heart rate was statistically same in both treatment groups. 1st minute: p-value=0.144, 3rd minute: p-value=0.000, 5th minute: p-value=0.011 and at 10th minute: p-value=0.448. Conclusion: According to the results of this study it was observed that oral gabapentin is effective in modifying hemodynamic response to nasotracheal intubation in normotensive patients undergoing elective maxillofacial surgeries. MAP (10th Minute: Group-A vs. Group-B: 0.000) & Heart Rate (10th Minute: Group-A vs. Group-B:0.448)

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Section: Resultsmentioning

confidence: 99%

Gabapentin

Boota

Nasir

Hyder

2018

TPMJ

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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%

“…One study 45 compared gabapentin with a beta blocker (esmolol). The only difference in hemodynamic variables was a higher HR at one minute in the gabapentin group when compared with the esmolol group (MD, 13 beatsÁmin -1 ; 95% CI, 4 to 21).…”

Section: Gabapentin Vs Fentanyl Clonidine or Beta Blockersmentioning

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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“…Obat-obat tersebut masing-masing memiliki keterbatasan sehingga terus dikembangkan penelitian untuk mendapatkan obat adjuvan yang mempunyai efek analgetik serta dapat meningkatkan kualitas analgesia opioid, mengurangi kebutuhan opioid, mencegah atau mengurangi toleransi opioid, mengurangi level kecemasan, serta mempunyai batas keamanan yang lebar. [1][2][3][4] Gabapentin secara kimiawi larut dalam air, memiliki rasa pahit, struktur berbentuk kristal putih mirip gugus gamma aminobutyric acid atau GABA dengan cincin cyclohexane. Aksi yang paling penting gabapentin adalah ikatan subunit α 2 δ voltage dependent calcium channels.…”

Section: Pendahuluanunclassified