Abstract
Background: The process of laryngoscopy and endotracheal intubation is usually associated with exaggerated haemodynamic response. In extreme cases this response may result in myocardial ischaemia, cardiac failure, increase in intracranial pressure and intracranial haemorrhage. Hence our prospective randomized double blinded placebo control study was designed to observe the effect of pregabalin in attenuating this haemodynamic response. Method: In this study, 100 adult patients of ASAPS I and II undergoing elective laparoscopic cholecystectomy were included. The patients were randomly allocated into two groups, group P received 150mg oral pregabalin and group C received similarly looking B complex capsules one hour before the surgery. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were observed. Sedation score was assessed using Ramsay sedation scale. Results: We observed an increase in all the haemodynamic parameters in both the groups. The percentage change in HR and MAP from baseline at one-minute following intubation was +33% and +28.5% in control group compared to +14% and +3% in pregabalin group. Similarly, the percentage change at five minutes after carboperitoneum was +24% and +26% in control group compared to +4% and +0.8% in pregabalin group. This difference was statistically significant with P value Conclusion: Oral pregabalin in a dose of 150mg one hour before the surgery is a safe and effective premedicant in attenuating pressor response to laryngoscopy, intubation and laparoscopy. It also produces good sedation without any adverse effects.
Highlights
In patients undergoing surgery under general anaesthesia, endotracheal intubation is the gold standard for securing the airway
The percentage change at five minutes after carboperitoneum was +24% and +26% in control group compared to +4% and +0.8% in pregabalin group
Significant variations in haemodynamics will occur if carboperitoneum is created with an intraabdominal pressure (IAP) higher than 10 mmHg which is characterized by decrease in cardiac output, increase in arterial pressures and increase in systemic and pulmonary vascular resistances
Summary
In patients undergoing surgery under general anaesthesia, endotracheal intubation is the gold standard for securing the airway. The procedure may cause activation of the sympathetic nervous system and release of catecholamines, resulting in a haemodynamic response that precipitates an increase in Heart Rate (HR) and Mean Arterial Pressure (MAP). This response does not cause problems in most patients; in high-risk patient groups, such as those with preexisting cardiovascular disease, it may increase the risk of myocardial ischaemia, myocardial infarction and mortality.[1,2,3] Significant variations in haemodynamics will occur if carboperitoneum is created with an intraabdominal pressure (IAP) higher than 10 mmHg which is characterized by decrease in cardiac output, increase in arterial pressures and increase in systemic and pulmonary vascular resistances. The process of laryngoscopy and endotracheal intubation is usually associated with exaggerated haemodynamic response In extreme cases this response may result in myocardial ischaemia, cardiac failure, increase in intracranial pressure and intracranial haemorrhage. Our prospective randomized double blinded placebo control study was designed to observe the effect of pregabalin in attenuating this haemodynamic response
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