Comparison of Oral Clonidine with Oral Pregabalin Premedication for the Attenuation of Pressor Response to Direct Laryngoscopy and Tracheal Intubation in Elective Surgery: A Prospective Randomized Study
,
Abstract
Background: Laryngoscopy and intubation has adverse effects like tachycardia, hypertension, myocardial ischemia and cerebral hemorrhage. There are many studies on various pharmacological agents to attenuate pressor response. Aim of the study was to compare efficacy and safety of oral clonidine versus oral pregabalin premedication to attenuate stress response in patients undergoing elective surgery.
Methods: 106 patients of American Society of Anesthesiologist (ASA) class I, aged between 18-60 years of either sex scheduled for elective surgery were randomized into two groups. Group A received oral clonidine 0.2mg and group B received oral pregabalin 150mg, 90 minutes before surgery. Primary objectives of the study heart rate(HR), systolic blood pressure(SBP) diastolic blood pressure(DBP) and mean blood pressure(MBP) were noted baseline, before induction, immediately after intubation (0) and at 1, 3, 5, 10 and 15 minutes after intubation. sedation, postoperative pain scores and any adverse effects were also noted.
Results: The demographic data were comparable in group A and group B. There was no significant difference at baseline for mean (SD) HR, SBP, DBP, and MBP in both groups (p>0.05). The mean (SD) HR was significantly lower in group A as compared to group B, before induction and at 1, 3, 5, 10 and 15 minutes (p <0.05). The mean (SD) SBP, MBP was significantly lower in group A as compared to group B, before induction immediately after intubation and at 1, 3, and 5 minutes (p <0.05). The mean (SD) DBP was significantly lower in group A as compared to group B, before induction (p 0.012). but post-operative analgesia was better in pregabalin group. Bradycardia was more in clonidine group and sedation was more with the use of pregabalin.
Conclusion: We concluded that oral premedication with either clonidine or pregabalin attenuates hemodynamic response to laryngoscopy and tracheal intubation, but Clonidine is superior to pregabalin.
[2] Fassoulaki A, Melemeni A, Paraskeva A, Petropoulos G. Gabapentin attenuate the pressor response to laryngoscopy and tracheal intubation. Br J Anaesth. 2006; 96(6):769-3.
[3] Abou-Madi MN, Keszler H, Yacoub JM. Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine. Can Anaesth Soc J. 1977; 24:12-9.
[4] Derbyshire DR, Smith G. Sympatho adrenal responses to anaesthesia and surgery. Br J Anaesth. 1984; 56(7):725-39.
[5] Kindler CH, Schumacher PG, Schneider MC, Urwyler A. Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: A double-blind, controlled clinical trial. J Clin Anesth. 1996; 8(6):491–6.
[6] Maguire AM, Kumar N, Parker JL, Rowbotham DJ, Thompson JP. Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anaesth. 2001; 86(1):90–3.
[7] Habib AS, Parker JL, Maguire AM, Rowbotham DJ, Thompson JP. Effects of remifentanil and alfentanil on the cardiovascular responses to induction of anaesthesia and tracheal intubation in the elderly. Br J Anaesth. 2002; 88(3):430–3.
[8] Shrestha GS, Marhatta MN, Amatya R. Use of gabapentin, esmolol or their combination to attenuate haemodynamic response to laryngoscopy and intubation. Kathmandu Univ Med J (KUMJ). 2011; 9(36):238-43.
[9] Mikawa K, Maekawa N, Kaetsu H, Goto R, Yaku H, Obara H. Effects of adenosine triphosphate on the cardiovascular response to tracheal intubation. Br J Anaesth. 1991; 67(4):410–5.
[10] Yoo KY, Jeong ST, Ha H, Lee J. Nitrous oxide attenuates pressor but augments norepinephrine responses to laryngoscopy and endotracheal intubation. Anesth Analg. 2003;96:1526-31.
[11] Hosseini VS, Yekta RA, Marashi S, Marashi SM, The Efficacy of Melatonin, Clonidine and Gabapentin in Reducing Preoperative Anxiety and Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Clinical Trial. Arch Anesth & Crit Care. 2015;1(4):120-5.
[12] Bajwa SJS, Kaur J, Singh A, Parmar S, Singh G, Kulshrestha A, et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian J Anaesth. 2012; 56(2):123-8.
[13] Ghai A, Gupta M, Rana N, Wadhera R. The effect of pregabalin and gabapentin on preoperative anxiety and sedation: a double blind study. Intensive Care. 2012;16(3):257-61.
[14] Ben-Menachem E. Pregabalin Pharmacology and Its Relevance to Clinical Practice. Epilepsia. 2004; 45:13–8.
[15] Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, et al. Pregabalin for the treatment of fibromyalgia syndrome: Results of a randomized, double-blind, placebo-controlled trial. Arthritis & Rheumatism. 2005; 52(4):1264–3.
[16] Rastogi B, Gupta K, Gupta PK, Agarwal S, Jain M, Chauhan H. Oral pregabalin premedication for attenuation of haemodynamic pressor response of airway instrumentation during general anaesthesia: A dose response study. Indian J Anaesth. 2012; 56(1):49–4.
[17] Gupta K, Sharma D, Gupta PK. Oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy: A comparative evaluation. Saudi J Anaesth. 2011; 5(2):179-84.
[18] Khajavi MR, Bahari S, Moharari RS, Pourfakhr P, Etezadi F, Imani F. The Clinical Effect of Oral Gabapentin/Clonidine Premedication on Postoperative Outcomes in Patients Undergoing Orthognathic Surgery. Arch Anesth & Crit Care. 2018; 4(2):455-8.
[19] Solanki SL, Bharti N, Batra YK, Jain A, Kumar P, Nikhar SA. The analgesic effect of intrathecal dexmedetomidine or clonidine, with bupivacaine, in trauma patients undergoing lower limb surgery: a randomised, double-blind study. Anaesth Intensive Care. 2013; 41(1):51-6.
[20] Waikar C, Singh J, Gupta D, Agrawal A. Comparative study of oral gabapentin, pregabalin, and clonidine as premedication for anxiolysis, sedation, and attenuation of pressor response to endotracheal intubation. Anesthesia: Essays and Researches. 2017; 11(3):558-60.
[21] Parveen S, Negi DS, Kumar R, Bagwan MC. Oral clonidine vs oral pregabalin premedication to attenuate pressor response to direct laryngoscopy in patients undergoing laparoscopic cholecystectomy: a randomized double blind study. J Clin Diagn Res. 2016; 10(9):21–5.
[22] Bahgat NM, Sadik SA, Mahdy WR, El-Sharkawy OA, Metwally AA, El-Shafey MK. The effects of using pregabalin versus clonidine premedication in laparoscopic cholecystectomy. Menoufia Med J. 2016; 29(3):530-8.
[23] Raval DL, Mehta MK. Oral clonidine premedication for attenuation of haemodynamic response to laryngoscopy and intubation. Indian J Anaesth. 2002; 46(2):124-9.
[24] Bhandari G, Mitra S, Shahi KN, Rani A, Chauhan A. Pre-emptive use of oral pregabalin attenuates the pressor response of laryngoscopy and endotracheal intubation: A double blind randomized placebo controlled study. Ann. Int. Med. Den. Res. 2016; 2(3):110-4.
[25] Aghamohammadi D, Farzin H, Fakhari S, Khanbabyi M. The Preemptive Effect of Pregabalin Single Dose on Opioid Consumption after surgery of Mandible Fracture: The Double-Blinded Clinical Trial. Arch Anesth & Crit Care.2019; 5:37–7.
[26] Raichurkar A, Dinesh K, Ravi M, Anand T, Somasekharam P. A comparative study of oral pregabalin and clonidine for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation. J Clin Biomed Sci. 2015; 5:29.
| Files | ||
| Issue | Vol 8 No 2 (2022): Spring |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v8i2.9147 | |
| Keywords | ||
| Blood Pressure Clonidine Intubation Laryngoscopy Pregabalin | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
