Attenuation of the haemodynamic responses to tracheal intubation with gabapentin, fentanyl and a combination of both: A randomised controlled trial.

BACKGROUND AND AIMS: We conducted a prospective, randomised, double-blind, controlled clinical trial to examine (1) whether a single preoperative dose of 800 mg gabapentin would be as effective as 2 µg/kg of intravenous (IV) fentanyl in blunting the haemodynamic response to tracheal intubation and (2) whether a combination of both would be more effective in this regard. METHODS: Seventy-five patients (American Society of Anaesthesiologists physical status I), aged 20-50 years were allocated into one of three groups: 2 µg/kg IV fentanyl, 800 mg oral gabapentin or a combination of both. Gabapentin was administered 2 h and fentanyl 5 min before induction of anaesthesia, which was achieved with 5 mg/kg thiopentone, and tracheal intubation facilitated with 0.1 mg/kg vecuronium. Laryngoscopy lasting a maximum of 30 s was attempted 3 min after administration of the induction agents. Serial values of mean arterial pressure (MAP) and heart rate (HR) were compared among the three groups and with the respective preinduction measurements. RESULTS: Patients receiving gabapentin 800 mg alone showed remarkable increases in HR and MAP in response to tracheal intubation (P < 0.05). The increases were similar for the other two regimens. These haemodynamic changes were lesser in patients receiving fentanyl and the combination of gabapentin and fentanyl. CONCLUSION: Oral gabapentin does not produce significant reduction in laryngoscopy and tracheal intubation induced sympathetic responses as compared to IV fentanyl or the combination of gabapentin and fentanyl.

Case report: telelaryngoscopy-guided flexible fiberoptic intubation for laryngeal rhinosporidiosis.

Rhinosporidiosis is a chronic granulomatous disease endemic in India and Sri Lanka. The causative microorganism, Rhinosporidium seeberi, remains a poorly understood pathogen, which has been described as an aquatic protistan parasite. Rhinosporidiosis presents as multiple polypoidal lesions affecting the mucosa of the nasal cavity, nasopharynx, and oropharynx. Intralaryngeal rhinosporidiosis is a rare entity and poses a challenge for management of the airway. In this case report, we highlight our technique in the management of the airway in a case of laryngeal rhinosporidiosis using a combination of fiberoptic bronchoscope and an endoscope. The technique was atraumatic and also avoided the potential for autoinoculation, which is a frequent cause of recurrence of this disease.