The use of Gabapentin, Clonidine, or Esmolol to attenuate the haemodynamic response to laryngoscopy and intubation

Laryngoscopy and intubation increases blood pressure and heart rate. The study aims to investigate the effect and safety of gabapentin, clonidine or esmolol on the haemodynamic response to laryngoscopy and intubation. Fiftysix ASA I and II patients undergoing elective surgery were randomly allocated to one of the four groups. First study drug was administered orally as gabapentin 1200mg or clonidine 200 μg or placebo. Second study drug was administered intravenously as esmolol 1.5mg/kg or normal saline. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at baseline and at 0, 1, 3 and 5 minutes after tracheal intubation. Rate pressure product (RPP) was calculated. Baseline values were compared with the values at various time intervals within the same group. Inter-group comparison was made for each time point. In Gabapentin group there was no increase in SBP and MAP in response to laryngoscopy and intubation but HR and RPP were signifi cantly high at 0, 1, 3 and 5 minutes. In Esmolol group, there was no increase in HR response to laryngoscopy and intubation but there was signifi cant high SBP and MAP at 0, 1, 3 and 5 minutes of intubation. In clonidine group, there was signifi cant increase in HR, SBP and MAP at 0 minute, which returned to baseline at 1 minute. The variables were similar to baseline at 3 and 5 minutes. No side effects were observed during the study. Gabapentin at 1200mg blunts mainly the hypertensive response to laryngoscopy and intubation while Esmolol at 1.5 mg/kg blunts mainly increase in heart rate response. Clonidine at 200mcg blunts both increase in blood pressure and heart rate response to laryngoscopy and intubation. Multicentered comparative studies involving larger patient population, is required to generalize our result. Also further studies regarding the combination of these agents and in sicker group of population (ASA III and IV) are to be considered.