Attenuation of hemodynamic responses following laryngoscopy and tracheal intubation

The present study was conducted to compare the effect of clonidine and gabapentin premedication in modifying the hyperdynamic response following laryngoscopy and tracheal intubation. Seventy-five ASA I-II patients of both sexes [37 males [49.3%], 38 females [50.7%]] 18 to 45 years [mean 32.8 +/- 8.65yr.] were randomly allocated into three equal groups [25 each]. Group-1 received 0.2 mg clonidine, Group-2 received placebo and Group-3 received 900 mg gabapentin, 120 minute before operation. Heart rate, systolic, diastolic and mean arterial blood pressure were measured before induction of anesthesia, before laryngoscopy, and 1, 3, 5, 10 min after intubation. Analysis revealed that the heart rate, systolic, diastolic and mean arterial blood pressure significantly differed between groups [p < 0.001, p = 0.003, p < 0.001, p < 0.001, respectively]. The highest rates of heart rate, systolic, diastolic and mean arterial blood pressure were in the placebo group and in one minute after laryngoscopy, and the lowest rate were in the gabapentin group at the time of 1, 3, 5 and 10 after laryngoscopy, except that the lowest rate of heart rate in 10 min after laryngoscopy was in clonidine group. The data propose that both clonidine and gabapentin have effective role in blunting hyperdynamic responses after laryngoscopy, more so with gabapentin

Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock

Through hypertonic and isotonic crystalloids are used nowadays in resuscitating patients in hemorrhagic shock, yet there is no sufficient data in support of either. The aim of this study was to compare the hemodynamic effects of hypertonic saline 5% and lactated ringer solutions when used for the resuscitation of patients in hemorrhagic shock. In a double-blinded randomized clinical trial, sixty adult patients in hemorrhagic shock admitted to the Emergency Department of a teaching Hospital between September 2005 and September 2006, were enrolled in this study. Patients were divided into two groups, The first group received lactated ringer 20 ml/kg, and the second group received 4 ml/kg of 5% hypertonic saline infused intravenously within 10 to 15 minutes followed by lactated ringer 10 ml/kg/hr. Hemodynamic parameters were measured at hospital admission as well as every 15 minutes for an hour and the results were compared between the two groups. Gastrointestinal bleeding was the most common cause of shock. There was a significant difference between the baseline and final hemodynamic parameters [MAP, HR, CVP] in each group; however, data of the two groups did not differ significantly. The PaO[2] was higher in the lactated ringer group and there was no difference in PaCO[2] neither in each group nor between the two groups. Both hyper and isotonic crystalloid solutions can improve hemodynamic status and the blood gas measurements, similarly; however, lactated ringer is a more potent solution in improving tissue oxygenation