Gabapentin reduces cardiovascular responses to laryngoscopy and tracheal intubation
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We have compared the effects of gabapentin on arterial pressure and heart rate at induction of anaesthesia and tracheal intubation in a randomized double-blind study.Ninety normotensive patients (ASA I) undergoing elective surgery were divided into three groups of 30 patients each. Patients received oral placebo (Group I), 400 mg of gabapentin (Group II) or 800 mg of gabapentin (Group III) 1 h prior to surgery in the operating theatre. After induction of anaesthesia heart rate and mean arterial pressure were recorded at baseline 1, 3, 5, 10 and 15 min after intubation.Patients receiving placebo and 400 mg gabapentin showed a significant increase in blood pressure and heart rate associated with tracheal intubation compared to baseline levels and Group III. There was significant decrease in heart rate and arterial pressure in Group III after intubation 1, 3, 5 and 10 min (P < 0.001, P < 0.001, P < 0.05 and P < 0.05, respectively) compared to Groups I and II.Given 1 h before operation gabapentin 800 mg blunted the arterial pressure and heart rate increase in first 10 min due to endotracheal intubation. Oral administration of gabapentin 800 mg before induction of anaesthesia is a simple and practical method for attenuating pressor response to laryngoscopy and tracheal intubation after standard elective induction.Keywords:
Mean arterial pressure
Changes in mean arterial blood pressure (MAP) and heart rate (HR) during short duration direct laryngoscopy and tracheal intubation were determined in 24 patients scheduled for elective coronary artery bypass graft operations. Direct laryngoscopy was started 1 minute after thiamylal 4 mg/kg and succinylcholine (SCh). Laryngotracheal lidocaine 2 mg/kg was administered immediately before placement of the tracheal tube. In addition, topical oropharyngeal anesthesia was produced with viscous lidocaine 10 minutes before induction of anesthesia in 6 patients, and 6 other patients received IV lidocaine 1.5 mg/kg 30 seconds before thiamylal-SCh administration. The remaining 12 patients received neither viscous nor IV lidocaine and served as a control group. The duration of direct laryngoscopy necessary to accomplish Iaryngotracheal lidocaine administration and tracheal intubation averaged less than 15 seconds. Maximal increases in MAP occurred 5 to 15 seconds after tracheal intubation and were not different (p>0.05) between groups, averaging 17 ± 3 torr (mean ± SE) for control patients, 14 ± 4 torr for patients treated with viscous lidocaine, and 22 ± 5 in patients receiving intravenous lidocaine. MAP decreased spontaneously after laryngoscopy and intubation and within 2 minutes after thiamylal-SCh was near awake levels. Heart rate did not change significantly during laryngoscopy and intubation. We conclude that a short-duration direct laryngoscopy combined with laryngotracheal lidocaine administration just before tracheal intubation minimizes pressor responses and insures a spontaneous return of MAP and HR towards awake levels following intubation. Viscous or IV lidocaine is not helpful when laryngoscopy is of a short duration.
Thiamylal
Mean arterial pressure
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The efficacy of 2 or 3 mg/kg diazoxide given 2.5 min before laryngoscopy in attenuating the cardiovascular responses to laryngoscopy and intubation was studied in 30 patients undergoing elective surgery. Data were compared with those from 10 control patients receiving saline. Anaesthesia was induced using 5 mg/kg thiopentone given intravenously and tracheal intubation was facilitated with 0.2 mg/kg vecuronium bromide. Patients receiving saline showed a significant increase in mean arterial pressure and rate – pressure product associated with tracheal intubation. The increases following tracheal intubation were significantly reduced ( P <0.05) in diazoxide-treated patients compared with those in the control group, but there were no significant differences in heart rate following tracheal intubation among the three groups. Data suggest that diazoxide can be used as a supplement during induction of anaesthesia to attenuate the hypertensive response associated with laryngoscopy and tracheal intubation.
Diazoxide
Tracheal tube
Rate pressure product
Mean arterial pressure
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We have compared the effects of gabapentin on arterial pressure and heart rate at induction of anaesthesia and tracheal intubation in a randomized double-blind study.Ninety normotensive patients (ASA I) undergoing elective surgery were divided into three groups of 30 patients each. Patients received oral placebo (Group I), 400 mg of gabapentin (Group II) or 800 mg of gabapentin (Group III) 1 h prior to surgery in the operating theatre. After induction of anaesthesia heart rate and mean arterial pressure were recorded at baseline 1, 3, 5, 10 and 15 min after intubation.Patients receiving placebo and 400 mg gabapentin showed a significant increase in blood pressure and heart rate associated with tracheal intubation compared to baseline levels and Group III. There was significant decrease in heart rate and arterial pressure in Group III after intubation 1, 3, 5 and 10 min (P < 0.001, P < 0.001, P < 0.05 and P < 0.05, respectively) compared to Groups I and II.Given 1 h before operation gabapentin 800 mg blunted the arterial pressure and heart rate increase in first 10 min due to endotracheal intubation. Oral administration of gabapentin 800 mg before induction of anaesthesia is a simple and practical method for attenuating pressor response to laryngoscopy and tracheal intubation after standard elective induction.
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Summary Using target‐controlled infusions (TCI) we aimed to determine the most appropriate dose of remifentanil required for intubation, using a steady effect‐site concentration of propofol and without the use of neuromuscular blocking drugs. Sixty ASA I−II patients presenting for elective surgery were randomly allocated to one of three groups. Anaesthesia was induced in all patients using a target‐controlled infusion of propofol 6.5 µ g.ml −1 . This was reduced to 3 µ g.ml −1 after 1 min. Each group received a different TCI of remifentanil, 19, 15 or 11 ng.ml −1 , which was reduced to 10, 8 or 6 ng.ml −1 , respectively, after 1 min. Laryngoscopy and intubation were attempted at 4 min. Laryngoscopy and ease of intubation were assessed using a standard scoring system. Intubation was considered satisfactory in 75% of patients in groups 1 and 2 and 35% of patients in group 3. Intubation was successful in 20/20, 19/20 and 15/20 patients in groups 1, 2 and 3, respectively. Pulse oximetry, heart rate and noninvasive arterial pressure were measured pre‐induction, and at intervals until after laryngoscopy and intubation. Mean arterial pressure (MAP) and heart rate decreased following induction of anaesthesia in all groups, which was statistically significant. Following laryngoscopy, MAP and heart rate increased, but were significantly less than the corresponding baseline values.
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Elective surgery
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BACKGROUND During the induction of general anaesthesia (GA), laryngoscopy and endotracheal intubation produce significant nociceptive stimuli, which frequently results in inadvertent activation of the sympathetic nervous system. To blunt this pressor response, many drugs are successfully used. However, administration of an additional drug might cause adverse haemodynamic effects or might unnecessarily increase the depth of anaesthesia. Hence, a non-pharmacological measure to reduce the response is preferred. In this study, we wanted tocompare haemodynamic responses between clinical assessment-guided tracheal intubation and neuromuscular block monitoring-guided tracheal intubation. METHODS An observational study was conducted on 62 patients aged 18 – 60 years old belonging to American Soceity of Anaesthesiologist (ASA) I & II posted for surgeries under general anaesthesia were allotted to 2 groups of 31 each. In Group C patients, the trachea was intubated after the clinical judgment of jaw muscle relaxation. In Group M patients, the trachea was intubated after train of four counts became zero in adductor pollicis muscle. Changes in heart rate [HR], mean arterial blood pressure [MAP], Krieg’s intubation score, time between the administration of a neuromuscular blocking agent and endotracheal intubation were recorded. The collected data was analysed by mean, standard deviation, frequency, percentage, ttest and chi square test. RESULTS HR and mean arterial pressure were significantly higher in Group C as compared to Group M after laryngoscopy and tracheal intubation (P < 0.05). The mean time required for intubation was significantly shorter in Group C compared to Group M (179.52 ± 2 s vs. 358.19 ± 55 s). Excellent and good intubation conditions were observed in all Group M patients, whereas 24 out of 31 patients (77 %) in Group C showed excellent and good intubation conditions. CONCLUSIONS Haemodynamic responses to laryngoscopy and tracheal intubation can be significantly attenuated if tracheal intubation is performed following complete paralysis of laryngeal muscles, detected by neuromuscular monitoring of adductor pollicis muscle. KEY WORDS Laryngoscopy, Intubation, Haemodynamic Responses, Stress Response, Neuromuscular Monitor.
Mean arterial pressure
Haemodynamic response
Muscle relaxation
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Blood pressure and heart rate changes during nasotracheal intubation under general anaesthesia were studied in 100 patients who were randomly allocated to fibreoptic bronchoscope or direct laryngoscopy intubation. Noninvasive blood pressure and heart rate were recorded before and immediately after anaesthesia induction, at anaesthesia intubation and every minute thereafter for 5 min. Nasotracheal intubation was accompanied by significant increases in blood pressure and heart rate compared to baseline values in both groups. Blood pressure and heart rate at intubation, and the maximum values of blood pressure during the observation were significantly higher in the fibreoptic bronchoscope group. However, the maximum values of heart rate were not significantly different between the two groups. Fibreoptic nasotracheal intubation may result in more severe pressor and tachycardiac responses than direct laryngoscopic nasotracheal intubation.
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Background . The stress response to laryngoscopy and intubation causes an undesirable increase in heart rate, blood pressure, and intraocular pressure. This study was designed to compare the effect of two doses of gabapentin on the stress response to laryngoscopy and intubation. Patients and Methods . (ASA I and II) 60 patients, aged from 18 to 60 years undergoing elective eye surgery requiring endotracheal intubation, were randomly allocated into 3 groups, 20 patients each. 2 hours before the surgery, group I received oral placebo, and groups II and III received oral gabapentin 800 mg and 1200 mg, respectively. Heart rate (HR), mean arterial pressure (MAP), and intraocular pressure (IOP) were measured before and after induction of anesthesia, immediately after, 5 minutes, and 10 minutes after intubation. Results . Gabapentin 1200 mg prevented the increase in HR, MAP, and IOP, secondary to laryngoscopy and intubation, and kept them below the baseline till 10 minutes after intubation (), while with gabapentin 800 mg, the increase in HR, MAP, and IOP was nonsignificant () and returned to levels below the baseline at 5 and 10 minutes after intubation. Conclusion . Preoperative gabapentin 1200 mg effectively prevented the stress response to laryngoscopy and intubation; meanwhile, gabapentin 800 mg only prevented significant stress response.
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Alfentanil
Rapid sequence induction
Thiopental Sodium
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We conducted a prospective, randomised, double-blind, controlled clinical trial to examine (1) whether a single preoperative dose of 800 mg gabapentin would be as effective as 2 μg/kg of intravenous (IV) fentanyl in blunting the haemodynamic response to tracheal intubation and (2) whether a combination of both would be more effective in this regard.Seventy-five patients (American Society of Anaesthesiologists physical status I), aged 20-50 years were allocated into one of three groups: 2 μg/kg IV fentanyl, 800 mg oral gabapentin or a combination of both. Gabapentin was administered 2 h and fentanyl 5 min before induction of anaesthesia, which was achieved with 5 mg/kg thiopentone, and tracheal intubation facilitated with 0.1 mg/kg vecuronium. Laryngoscopy lasting a maximum of 30 s was attempted 3 min after administration of the induction agents. Serial values of mean arterial pressure (MAP) and heart rate (HR) were compared among the three groups and with the respective preinduction measurements.Patients receiving gabapentin 800 mg alone showed remarkable increases in HR and MAP in response to tracheal intubation (P < 0.05). The increases were similar for the other two regimens. These haemodynamic changes were lesser in patients receiving fentanyl and the combination of gabapentin and fentanyl.Oral gabapentin does not produce significant reduction in laryngoscopy and tracheal intubation induced sympathetic responses as compared to IV fentanyl or the combination of gabapentin and fentanyl.
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