Comparative evaluation of oral gabapentin versus clonidine as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anesthesia

Abstract

Background:Laryngoscopy and endotracheal intubation (L and I) is associated with rise in blood pressure (BP), heart rate (HR), leading to adverse cardiological outcome especially in susceptible individuals. To compare the BP, HR during L and I as well as to evaluate the preoperative sedation status between oral clonidine (Group C) and oral gabapentine (Group G) as premedication for the patients undergoing major surgery under general anesthesia (GA).Materials and Methods:From April 2008 to December 2009; in a prospective, double-blinded, and randomized controlled study; 100 adult patients of either sex, aged 20-45, of American Society of Anesthesiologists status I and II scheduled to undergo major surgery of >1 hour duration, randomly allocated into groups C and G were pre treated with oral clonidine (200 µg) and gabapentin (800 mg) respectively 2 h prior to induction. Preoperative sedation was assessed 2 h after premedication administration. Hemodynamic parameters were noted just before induction, during L and I 1,3,5,7, and10 min after intubation. The results obtained were then analyzed with statistical unpaired “t” test and Chi-square test and compared.Results and Analysis:Preoperative sedation between two groups were similar but group C attenuated HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) more significantly before induction, during L and I, 1, 3, and 5 min, following L and I, while comparing with group G. Again gabapentin-reduced HR, BP, (SBP, DBP, MBP) significantly more at 7 and 10 min after L and I on comparison clonidine.Conclusion:Oral clonidine is equally effective in producing preoperative sedation in comparison to oral gabapentin, while on the contrary oral clonidine is more efficacious in reducing laryngoscopic stress response than oral gabapentin.

A Comparison Between the Effects of Single-Dose Oral Gabapentin and Oral Clonidine on Hemodynamic Parameters in Laparoscopic Surgeries: A Randomized Controlled Trial

“…Also, our results are in concordance with Singhal et al [ 5 ] who compared oral clonidine 200 mcg and gabapentin 900 mg administered 90 minutes before induction, which showed blood pressure below baseline in the clonidine group in comparison with the gabapentin group. However, our results are slightly different from those of the study conducted by Majumdar et al [ 4 ] in which oral clonidine (200 mcg) and oral gabapentin (600 mg) were administered before surgery, and clonidine was found to be better at attenuating hemodynamic parameters before induction, during laryngoscopy, and orotracheal intubation at zero, first, third, and fifth minutes while gabapentin attenuated HR and MAP at seventh and 10th minutes. This may be due to the high dose of gabapentin administered in this trial compared to our study.…”

“…Pneumoperitoneum created during laparoscopy results in hypercapnia, which in turn causes adverse cardiac effects such as tachycardia, hypertension, an increase in systemic vascular resistance, and a decrease in cardiac output [ 3 ]. The adverse cardiac effects due to pneumoperitoneum can be aggravated by the pressor response to laryngoscopy and endotracheal intubation [ 4 , 5 ]. Many pharmacological agents like clonidine and gabapentin have been evaluated as oral premedications; moreover, intravenous drugs such as vasodilators (nitroglycerine), opioids (fentanyl), beta-blockers (esmolol), and calcium channel blockers can be administered prior to abdominal insufflation to attenuate the hemodynamic response to pneumoperitoneum [ 6 , 7 ].…”

Effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients in southwestern Iran: a randomized clinical trial

“…Fulas et al [ 27 ] described a topical combination of clonidine and pentoxifylline that significantly affects neuropathic pain. A research article by Majumdar et al [ 40 ] revealed that gabapentin and clonidine have similar soothing effects before surgeries. Hence clonidine is more effective on laryngoscopy compared to gabapentin.…”