TO STUDY EFFECT OF GABAPENTIN ON ATTENUATION OF PRESSOR RESPONSE TO DIRECT LARYNGOSCOPY AND TRACHEAL INTUBATION AND ON PERIOPERATIVE PAIN
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2017, Vol 4, Issue 43
Abstract
BACKGROUND Endotracheal intubation was first described by Rowbotham and Magill in 1921.1 In 1940 Reid and Brace first described hemodynamic response to Laryngoscopy and Intubation due to Noxious stimuli.2 The circulatory responses to laryngeal and tracheal stimulation are due to sympathoadrenal stimulation.3 Laryngoscopy and Tracheal Intubation induces changes in circulating Catecholamine levels significantly. Norepinephrine, Epinephrine and Dopamine levels rise, but the raise in Norepinephrine levels is consistently associated with elevation of Blood pressure and Heart rate.4 Even though the elevation in Blood pressure and Heart rate due to Laryngoscopy and Intubation are brief, they may have detrimental effects in high risk patients including Myocardial Infarction, Cardiac failure, Intracranial haemorrhage and increases in Intracranial pressure.5 Many strategies have been advocated to minimize these hemodynamic adverse responses and aimed at different levels of the reflex arc.6 Block of the peripheral sensory receptors and afferent input is by topical application and infiltration of Local Anaesthetic to Superior laryngeal nerve. Block of central mechanism of integration and sensory input by drugs like Fentanyl, Morphine etc. Block of efferent pathway and effector sites IV Lignocaine, Beta blockers, Calcium channel blockers, Hydralazine etc. No single drug or technique is satisfactory. The aim of this study is to evaluate the efficacy of Gabapentin in attenuating hemodynamic response to laryngoscopy and intubation in a placebo controlled double blind study. MATERIALS AND METHODS A clinical comparative study of attenuation of sympathetic response to laryngoscopy and intubation was done in 150 patients posted for elective surgery divided into two groups and were randomly allocated Group 1 – placebo capsules with sugar and Group 2 – Gabapentin 300 mg capsules. Heart rate, systolic, diastolic blood pressure, mean arterial pressure were recorded at 1, 3, 5 and 10 minutes intervals from onset of laryngoscopy. RESULTS In Gabapentin group there was significant suppression of heart rate and blood pressure when compared to the control group which returned to baseline at the end of 10 minutes of laryngoscopy. CONCLUSION In patients with no drugs to attenuate the sympathetic response to laryngoscopy and intubation the maximum raise in heart rate and blood pressures were statistically and clinically very highly significant and can be detrimental in high-risk patients. Gabapentin significantly attenuates the sympathetic response to laryngoscopy and tracheal intubation.
Authors and Affiliations
Sarita Chandapet, Fariah Fatima
Keywords
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- EP ID EP219932
- DOI 10.18410/jebmh/2017/528
- Views 68
- Downloads 0
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