DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20213362

A comparative study of efficacy of oral pregabalin and clonidine for attenuation of pressor response to intubation

Haramritpal Kaur, Jatin Gupta, Amandeep Singh, Gurpreet Singh, Anshul Dahuja, Parveen Rajora, Rubina Rana, Naresh Baghla

Abstract


Background: Endotracheal intubation is associated with hemodynamic stress responses. Various drugs have been used in the past to attenuate the pressor response; however, none has been proved to be ideal. Present study was planned to evaluate the oral pregabalin 150 mg and clonidine 200 µg for attenuation of pressor response to intubation.

Methods: The study was conducted on 100 adult patients of either gender scheduled to undergo elective surgeries under general anaesthesia (GA). The patients were randomly allocated into 2 groups. In group A patients received pregabalin 150mg and in group B patients received clonidine 200µg orally. The hemodynamic parameters were recorded until 10 minutes after intubation. The sedation, anxiety and side effects were also assessed.

Results: In clonidine group, the mean HR remained below the baseline value at all the time intervals. In pregabalin group, the mean HR remained below the baseline value at most of the time intervals but increased above baseline just after intubation (T0i) and 1 minute after intubation (T1i) where increase was only 1.488±1.20% and 0.45±1.16% respectively from baseline. In both pregabalin and clonidine groups, the mean SBP and MAP remained below the baseline value (Tb) at all the time intervals from T0.5 to T10i. Both clonidine and pregabalin provided adequate anxiolysis and sedation with pregabalin providing more pronounced sedation and anxiolysis than clonidine.

Conclusions: Both clonidine and pregabalin are effective oral premedication drugs for attenuation of the pressor response to laryngoscopy and endotracheal intubation.

 


Keywords


Clonidine, Pregabalin, Pressor response, Laryngoscopy, Intubation

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References


King BD, Harris LC. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anaesthesia. Anesthesiol. 1951;12950:556-66.

Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1996;8:63-79.

Reid LC, Brace DE. Irritation of the respiratory tract and its reflex effect upon the heart. Surg GynecObst. 1940;70:157.

Burstein CL, Lopinto FJ, Newman W. Electrocardiographic studies during endotracheal intubation: effects during usual routine tech-niques. Anesthesiol. 1950;11:224-37.

AbouMadi MN, Keszler H, Yocoub JM. Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous dose of lidocaine. Cand Anaesth Soc J. 1977;24:9-12.

Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: intravenous or laryngotracheal?. Anesthesiol. 1981;55:578-81.

Coleman AJ, Jordan C. Cardiovascular responses to anaesthesia: influence of beta adrenoreceptor blockade with metoprolol. Anaesthesia.1980;35:972-8.

Fassoulaki A, Kaniaris P. Intranasal administration of nitroglycerine attenuates pressor response to laryngoscopy and intubation of trachea. Br J Anaesth. 1983;55:49-52.

Davis MJ, Cronin KD, Cowie RW. The prevention of hypertension at intubation: A controlled study of intravenous hydralazine on patients undergoing intracranial surgery. Anaesthesia. 1981;36:147-51.

Mikawa K, Obara H, Kusunoki M. Effect of nicardipine on cardiovascular response to tracheal intubation. Br J Anaesth. 1990;64:240-2.

Salihoglu Z, Demiroluk S, Demirkiran. Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidly obese patients. Eur J Anaesthesiol. 2002;19:125-8.

Sundar AS, Kodali R, Sulaiman S, Ravullapalli H, Karthekeyan R. The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid sparinge ffect in patients undergoing off-pump coronary artery bypassgrafting. Ann Car Anaesth. 2012;15:18-25.

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. Anesth Essays Res. 2017;11:558-60.

Singh M, Choudhury A, Kaur M, Liddle D, Verghese M, Balakrishnan I. The comparative evaluation of intravenous with intramuscular clonidine for suppression of haemodynamic changes in laparoscopic cholecystectomy. Saudi J Anaesth. 2013;7:181-6.

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.

Raichurkar A, Dinesh K, Ravi M, Talikoti AT, Somasekharam P. A comparative study of oral pregabalin and clonidine for attenuation of hemodynamic re-sponses to laryngoscopy and tracheal intubation. J Clin Biomed Sci. 2015;5:25-9.

Thomas LS, Vishma K. A comparison of oral pregabalin and oral clonidine for the attenuation of haemodynamic response to laryngoscopy and endotracheal intubation and the time for rescue analgesic in thyroid surgeries. Int J Sci Res. 2019;8:61-3.

Soni M, Grover N, Sood S. A comparative clinical evaluation of oral clonidine vs. pregabalin premedication for attenuation of haemodynamic response to laryngoscopy and intubation- a prospective randomised double blinded placebo-controlled study. J Evid Based Med Health. 2019;6:684-90.

Chandra A, Yathish SK, Gupta A, Agarwal DN, Chopra R. Oral premedication with pregabalin or clonidine for attenuating the pressor response to laryngoscopy and tracheal intubation in laparoscopic cholecystectomy. Med J DY Patil Vidyapeeth. 2018;11:532-8.