PreMedication to Attenuate Pressor Response to Direct Laryngoscopy and Endotracheal Intubation

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PreMedication to Attenuate Pressor Response to Direct Laryngoscopy and Endotracheal Intubation

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Introduction: Laryngoscopy and endotracheal intubation are routine procedures of modern balanced general anesthesia technique. Endotracheal intubation has become an integral part of the anesthetic management and critical care of the patient and has been practiced following its description by Rowbotham and Magill in 1921. Materials and Methods: Present clinical study was conducted in Department of Anesthesiology, Subbaiah Institute of Medical Science and Research Centre, Purle, Shivamogga. After approval from the hospital ethics committee, study was conducted during the period between October 2016 and September 2018. It was a prospective study. A total of 60 patients undergoing elective surgery were selected. Patients in each group received respective drugs as per timing and dose mentioned earlier. On arrival in the operating room, patient’s basal parameters-Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MBP), Rate Pressure Product (RPP) and Electrocardiography are monitored using, pulse oximetry, Non-invasive Blood Pressure (NIBP), and ECG monitor. Intravenous access using 18 G cannula was established and an I.V. infusion of ringer lactate was started. All patients were pre-oxygenated with 100% oxygen for 3 minutes before induction with a tight fitting face mask. Results: All the patients received Tab. Alprazolam for night sedation, day before. One hour before the expected time of induction, Group P received tab. Pregabalin 150 mg orally with sips of water and Group C received 0.3 mg orally with sips of water. Base line parameters, after pre-medication, after induction and subsequently at 1 minute, 3 minutes, 5 minutes, and 10 minutes post-intubation were recorded. Data was tabulated and analyzed using Microsoft Office version 2010. The demographic profile (age wise, gender wise and weight wise distribution) was comparable in all the groups. Laryngoscopy and endotracheal intubation resulted in increased heart rate and blood pressure (SBP, DBP and MAP) in all the groups with maximum values at 1 minute. The percentage rise in hemodynamic parameters was as given below Heart Rate: 10% rise above the baseline in Pregabalin Group 7.8% fall from the baseline in Clonidine Group Systolic blood pressure: 9.65% rise above the baseline in Pregabalin Group 4.67% rise from the baseline in Clonidine Group, Diastolic blood pressure: 11.91% rise above the baseline in Pregabalin Group 7.91% rise from the baseline in Clonidine Group, Mean arterial pressure: 11.16% rise above the baseline in Pregabalin Group, 7.72% rise from the baseline in Clonidine group. Conclusion: Both oral Clonidine 0.3 mg and Oral Pregabalin 150 mg effectively attenuates the hemodynamic response to laryngoscopy and endotracheal intubation. Clonidine was found to be more effective than Pregabalin in lowering of blood pressure and heart rate changes associated with laryngoscopy and endotracheal intubation. Pregabalin gives better post-operative analgesia, more sedation and less bradycardia as compared to Clonidine.

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