Résumé
Background&Objectives: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy, intubation and extubation. The reflex increases in sympathoadrenergic activity caused by these manipulations leads to an increase in catecholamine release, arterial blood pressure and heart rate. The aim of present study was to evaluate the efficacy of Fentanyl (2 mcg/kg), Esmolol (1mg/kg) and their combination in half the dose(fentanyl 1 mcg/kg +esmolol 0.5mg/kg) in attenuating the pressure response during laryngoscopy and tracheal intubation. Methods: This is a prospective double blind study comprising ninety patients between 21-60 yrs and ASA grade I and II scheduled for elective surgery under general anesthesia. Patients were randomly divided into group E (injection Esmolol 1mg/kg iv), group F (inj.Fentanyl 2mcg/kg iv) and group C (inj.Esmolol 0.5mg/kg and inj.Fentanyl 1mcg/kg). The study drug was given 2 minutes before induction of anaesthesia. All the vital parameters of patients were observed during intra operative and postoperative period .Values of heart rate and mean blood pressure were recorded at pre-induction, after giving study drug, after induction, immediately after intubation and at 1 min, 3 min, 5 min, 7 min and 10 min. after intubation. Results: Inter group comparison of groups E, F & C showed greater attenuation of heart rate in group F as compared to group C and group E. Inter group comparison of groups E, F & C in attenuating increase in MAP showed greater attenuation of MAP in group F as compared to group E ( p=0.880) and group C (p=0.0005). Conclusion: Among the fentanyl (2 mcg/kg), esmolol (1 mg/kg) and their combination drug in half doses, injection fentanyl is best in attenuating haemodynamic responses to laryngoscopy and tracheal intubation.
Résumé
The effects of gabapentin on arterial pressure and heart rate were compared at induction of anaesthesia and at tracheal intubation in a prospective randomized double blind study. Fourty patients of American society of Anaesthesiologists (ASA) physical status I undergoing elective surgery were divided in two groups of twenty each. Twenty patients received oral placebo (Group P), and 20 patients received 900 mg of gabapentin (Group G), 2 hours prior to induction of anaesthesia. Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and Heart rate (HR) were recorded one minute before and after induction of anaesthesia, immediately after intubation and 1,3,5 and 10minutes after intubation. Changes in SBP were statistically insignificant in both the groups. In the gabapentin group, at 0 and 5 minutes, the DBP was significantly less than the placebo group (p<0.05). There was a significant decrease in heart rate in Group G as compared to Group P (p<0.05).Pre medication with 900 mg gabapentin, 2 hours before induction of anaesthesia attenuates the tachycardia associated with laryngoscopy and intubation but not the pressor response completely.