Comparative study of risks and benefits of oral clonidine and oral gabapentin premedication in attenuating the hemodynamic response following laryngoscopy and tracheal intubation

Dr. Prateek Singh; Dr Satyam Yadav

Volume : IX, Issue : IV, April - 2020

Comparative study of risks and benefits of oral clonidine and oral gabapentin premedication in attenuating the hemodynamic response following laryngoscopy and tracheal intubation

Dr. Prateek Singh, Dr Satyam Yadav

Abstract :

To evaluate & compare the benefits and risks of clonidine and gabapentin. this randomized double blind study was conducted in dept of anaesthesia Safdarjung Hospital, New Delhi. 99 ASA–1 Adults patients (18–45 years) of either sex scheduled for elective orthopaedic and general surgical procedures were enrolled into the study. Sample of 99 patients was required assuming effect size as 30%, level of significance 5%, power of study 75% using independent t–test on software G–power–3.1. Patients with (BMI) Body mass index more than 30,hiatal hernia, gastroesophageal reflux, history of allergy to study drugs history of cardiovascular (HT, MI), neurologic, cereovascular, respiratory, hepatic and renal disease and patients having difficult intubation (prolonged laryngoscopic time more than 30 seconds) or requiring urgent surgery were excluded from the study. Patients were randomly divided into 3 equal groups of 33 each according to a computerised random table. All patients received premedication drugs 120 minutes before admission to the operating room. GROUP–1. Patients received 0.25mg alprazolam HS night before surgery & 0.3mg clonidine tablets 2 hours before surgery. GROUP–2. Patients received 0.25mg alprazolam HS night before surgery & 600 mg gabapentin tablets 2 hours before surgery. GROUP–1.Patients received only 0.25mg alprazolam HS night before surgery. All patients underwent pre–medication with tablet alprazolam 0.25 mg and rantac 150 mg night before the surgery.They received the designated study drug on the morning 2 hour prior to the planned surgery by a person not actively involved in the study. In the operation theatre intravenous cannula, ECG, NIBP, Pulse Oximeter applied. Inside the O.T. after commencing standard monitoring for ECG, NIBP, SPO2, three baseline readings for heart rate and blood pressure were taken at interval of 1 minute, the mean of three readings was taken as baseline parameter. Patients received 2 mcg/kg fentanyl and 0.03mg/kg midazolam intravenously 5 minutes before induction of anaesthesia. All patients will be preoxygenated for 3 min with 100% oxygen and anaesthesia was induced with 5mg/kg thiopental sodium. The patient was intubated with appropriate size ETT & macintosh blade 3 minutes after neuromuscular blockade with 0.1mg/kg vecuronium omide. Anaesthesia was maintained with 50% N2O in oxygen with 0.8% Isoflurance. Heart rate, systolic, diastolic and mean arterial blood pressure was recorded before induction of anaesthesia, before laryngoscopy and at 1, 3, 5 & 10 minutes after intubation. In our study, Hypertension was defined as SBP > 25% of baseline or 150 mm Hg which ever was higher. Hypotension was defined SBP < 25% of baseline value or 90 mm Hg which ever was lower. Tachycardia was defined as HR > 25% of baseline. Bradycardia was defined as HR < 50 beats/min or decrease in more than 25% of baseline. Arrhythmia was defined as ventricular or supra ventricular premature beat or any rhythm other than sinus. Incidence of all these parameter were recorded in all three groups. If hypertension occurred within 7 minutes, isoflurane was increased. If there was hypotension in above period, then fluid challenge was given. If there was tachycardia associated with hypotension then fluid challenge was given or if associated with hypertension then isoflurane was increased + narcotic was added. If there was adycardia then that was treated with injection atropine. Conclusion: The pressure response to intubation is a detrimental factor in patients. Hence we compared clonidine and gabapentin in fixed doses to know their effectiveness in reducing the haemodynamic responses to intubation.