Title: Evaluation of Oral Pregabalin Premedication for Attenuation of Pressor Response during Laryngoscopy and Endotracheal Intubation – A Randomised Clinical Study
Authors: Gagandeep Singh, Pavan Dhulkhed, Indrajit Gupta, V.K.Dhulkhed, Bilal Mohammad, Tushar Munnoli
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.37
Background & Objective: This clinical study was designed to evaluate and compare single preoperative dose of pregabalin to placebo regarding hemodynamic responses to laryngoscopy and endotracheal intubation, to assess perioperative fentanyl requirement and any side effects. Methods: 60 ASA I and II patients undergoing elective surgical procedures were randomly selected and divided into 2 groups of 30 each. Group A received placebo and Group B received pregabalin 150mg orally 1hour before induction. The patients were compared for hemodynamic changes before the start of surgery, after induction, 1, 3, 5 & 10 minutes after intubation. Additionally fentanyl requirement during surgery and analgesia requirement during first 24 hrs of post operative period was also compared. Result: Preoperative sedation levels were higher with pregabalin premedication. Oral pregabalin significantly attenuated the heart rate(HR), systolic blood pressure(SBP),diastolic blood pressure (DBP) and mean arterial pressure( MAP) due to laryngoscopy and endotracheal intubation. Conclusion: The present study shows that single oral dose of 150mg pregabalin given 1hr before surgery attenuated the pressor response to tracheal intubation in adults, has adequately sedated the patients and was devoid of side effects in the given dose. 1. Reid LC, Brace DE. Irritation of the respiratory tract and its reflex effect upon heart. Surg Gynaec & Obst. 1940;70:157–62. 2. Kovac AL. Controlling the haemodynamic response to laryngoscopy and endotracheal intubation. Journal of Clinical Anaesthesia 1996;8:63-79. 3. Prys-Roberts C, Greene LT, Foex P. Studies of anaesthesia in relation to hypertension II: Haemodynamic consequ-ences of induction and endotracheal intubation. Br J Anaesth 1971; 43:531. 4. Dalton B, Guiney T. Myocardial ischemia from tachycardia and hypertension in coronary heart disease – Patients undergoing anaesthesia. Boston: Ann Mtg American Society of Anaesthesiologists; 1972.pp. 201-2. 5. Korpien R, Sarnivaara L, Siren K, Sarna S. Modification of the haemodyamic respon-ses to induction of anaesthesia and tracheal intubation with alfentanil, esmolol and their combination. Can J Anaesth. 1995;42:298–304. 6. Helfman SM, Gold MI, Delisser EA, Herrington CA. Which drug prevents tachycardia and hypertension associated with tracheal intubation: Lidocaine, Fentanyl, or Esmolol? Anesth Analg. 1991;72:82–6. 7. Kelhet H, Dahl JB. Anaesthesia, surgery and challenges in post-operative recovery. Lancet 2003; 362: 1921-8. 8. Ben-Menachem E. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia. 2004;45:13–8. 9. Rastogi Bhawan , Kumkum Gupta, Prashant Gupta, et al Oral pregabalin premedication for attenuation of haemodynamic pressor response of airway instrumentation during general anesthesia. indian journal of anaesthesia vol 56, 49-54, issue 2,jan-feb 2012. 10. A.J. Shribman, G. Smith, K.J. Achola Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation Br J Anaesth, 59 (1987), pp. 295–299. 11. Hassan HG, EL-Sharkawy TY, Renk H, Mansour G, Fouda A. Hemodynamic and catecholamine stress responses to laryngoscopy with vs without endotracheal intubation. ActaAnesthesiolScand. 1991;35:442–7. 12. Kumkum Gupta, Pranav Bansal,Prashanth K Gupta, YP Singh. Pregabalin premed-ication – A new treatment option for hemodynamic stability during general anaesthesia. Anesthesia Essays and resear-ches Vol 5, Issue 1, year 2011, 57-62. 13. Ayya Syama Sundar, Rajeshkumar Kodali, Sajith Sulaiman,et al. The effect of preemptive Pregabalin on attenuation of stress response to endotracheal intubation and opioid sparing effect in patient undergiong off pump coronary artery bypass grafting. Annals of Cardiac Anaesthesiay 2012 Vol 15, Issue 1, 18-25. 14. Guttuso T Jr1, Roscoe J, Griggs J. Effect of gabapentin on nausea induced by chemotherapy in patients with breast cancer Lancet. 2003 May 17;361 (9370):1703-5. Gagandeep Singh Department of Anaesthesiology Krishna Institute of Medial Sciences, Karad, MaharashtraAbstract
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