Evaluation of Oral Pregabalin Premedication for Attenuation of Haemodynamic Response during Tracheal Intubation in Adult Patients with Controlled Hypertension For Elective Surgery
Abstract
Background: The laryngoscopy and tracheal intubation is a noxious stimuli resulting in transient but marked sympathetic response. This response is exaggerated in patients with hypertension. This study evaluated the role of oral pregabalin premedication in attenuation of haemodynamic response during tracheal intubation in adult patients with controlled hypertension posted for elective surgery.
Methods: A prospective double blinded randomized study was carried out in a total of 60 adult patients (aged 18-65 years, either gender) with controlled hypertension after being randomized into two groups with 30 patients in each. Prior to induction, Group PL received Placebo (multivitamin) and Group PB received pregabalin 75mg tablet 1 hour. The anaesthesia technique was standardized as per department protocols. Both groups were evaluated for pre-operative sedation, haemodynamic changes after premedication, before and after induction, after the laryngoscopy and tracheal intubation and post-operative side effects.
Results: There was attenuation of haemodynamic responses without significant side effects with pregabalin. Statistically significant increase in post intubation systolic, diastolic and mean blood pressure was seen in group PL as compared to group PB. In both groups, a reduction in heart rate was observed and was statistically significant 1 minute after intubation in group PB. Pre-operative sedation levels were higher in PB group in comparison to PL group. No post-operative side effects observed in both the groups.
Conclusion: In controlled hypertensive patients, oral pregabalin 75 mg attenuated the haemodynamic responses to laryngoscopy and tracheal intubation. It produced effective pre-operative sedation without any post-operative side effects.
[2] Saha U, Jayalakshmi TS. Pressor response in hypertension. Indian J Anaesth. 2003; 47:443–9.
[3] Prys-Roberts C, Greene LT, Meloche R, Foëx P. Studies of anaesthesia in relation to hypertension. II: Hemodynamic consequences of induction and endotracheal intubation. 1971. Br J Anaesth. 1998; 80(1):106-22; discussion 104-5.
[4] Sebastian B, Talikoti AT, Krishnamurthy D. Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomidine: A comparison between two doses. Indian J Anaesth. 2017; 61(1):48-54.
[5] Choudhary S, Sharma S, Kumari I, Kalluraya S, Meena K, Dave T. Comparative evaluation of oral melatonin and oral clonidine for the attenuation of haemodynamic response to laryngoscopy and tracheal intubation-A prospective randomised double blind study. Indian J Anaesth. 2020; 64(8):696-703.
[6] 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.
[7] Maguire AM, Kumar N, Parker JL. Comparison of the effects of remifentanyl and alfentanyl on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anesth. 2001; 86:90-3.
[8] Parida S, Ashraf NC, Mathew JS, Mishra SK, Badhe AS. Attenuation of the haemodynamic responses to tracheal intubation with gabapentin, fentanyl and a combination of both: A randomised controlled trial. Indian J Anaesth. 2015; 59(5):306-11.
[9] Fassoulaki A, Melemeni A, Paraskeva A, Petropoulos G. Gapapentin attenuates the pressor response to direct laryngoscopy and tracheal intubation. Br J Anesth. 2006; 96:769-73.
[10] Ali R, El Gohary H. Efficacy of preoperative oral gabapentin in attenuation of neuroendocrine response to laryngoscopy and endotracheal intubation. J Med Sci. 2009; 9:24-9.
[11] Gajraj NM. Pregabalin: its pharmacology and use in pain management. Anesth Analg. 2007; 105(6):1805-15.
[12] Ben-Menachem E. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia. 2004; 45:13-8.
[13] Singh G, Dhulkhed P, Gupta I, Dhulkhed V K, Mohammad B, et al. Evaluation of oral pregabalin premedication for attenuation of pressor response during laryngoscopy and endotracheal intubation-A randomized clinical study. JMSCR 2016; 4(145)16-25.
[14] Gupta K, Bansal P, Gupta PK, Singh YP. Pregabalin premedication - A new treatment option for hemodynamic stability during general anesthesia: A prospective study. Anesth Essays Res. 2011; 5(1):57-62.
[15] 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; 56:49-54.
[16] Sundar AS, Kodalin R, Sulaiman S, Ravullapalli H, Karthekeyan R, et.al. The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid sparing effect in patients undergoing off pump coronary artery bypass grafting. Ann Card Anaesth. 2012; 15:18-25.
[17] 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; 2:110-4.
[18] Dhyanya PR, Franklin D. Effect of oral pregabalin on hemodynamic stress response to laryngoscopy and endotracheal intubation. JMSCR 2017; 5(4):20678-84.
[19] Meena R, Meena K, Prakash S. Attenuation of cardiovascular response during laryngoscopic intubation using two different doses of pregabalin in controlled hypertensive patients. J Anesth Clin Res. 2016; 7:2-5.
[20] Khan AA, Gani S, Munshi FA, Saleem B, Hameed S, Ahmad Rather M. A comparative trial studying the effectiveness of oral clonidine and pregabalin premedication in attenuation of haemodynamic response following laryngoscopy and endotracheal intubation. JEMDS. 2015; 4:7134-143.
[21] Paul F. White, Bureu Tufanogullari, Jimmie Taylor, Kevin Klein. The effect of pregabalin on preoperative anxiety and sedation levels: a dose ranging study. Anesth Analg. 2009; 108:1140-5.
[22] 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; 5:179-84.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Controlled hypertension Tracheal intubation Haemodynamic response Pregabalin | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
