Oral pregabalin as premedication on anxiolysis and stress response to laryngoscopy and endotracheal intubation in patients undergoing laparoscopic cholecystectomy: A randomized double-blind study

Georgiyants

EUREKA: Health Sciences

2019

Multimodal analgesia for lumbar spine surgery is still a controversial problem, because of possible fusion problems, significant neuropathic component of pain, and influence of anesthesia type. Aim of the study was to assess the efficacy of pain management after lumbar spine surgery considering characteristics of pain, type of anesthesia and analgesic regimen. Material and methods. 254 ASA I-II patients with degenerative lumbar spine disease were enrolled into prospective study. Patients were operated either under spinal anesthesia (SA) or total intravenous anesthesia (TIVA). In postoperative period patients got either standard pain management (SPM – paracetamol±morphine) or multimodal analgesia (MMA – paracetamol+parecoxib+pregabalin±morphine). Results. We revealed neuropathic pain in 53.9 % of patients, who were elected for lumbar spine surgery. VAS pain score in patients with neuropathic pain was higher, than in patients with nociceptive pain. Total intravenous anesthesia was associated with greater opioid consumption during the first postoperative day. Multimodal analgesia based on paracetamol, parecoxib and pregabalin allowed to decrease requirements for opioids, postoperative nausea and dizziness. Pregabalin used for evening premedication had equipotential anxiolytic effect as phenazepam without postoperative cognitive disturbances. Conclusions. Multimodal analgesia is opioid-sparing technique that allows to decrease complications. Spinal anesthesia is associated to a decreased opioid consumption in the 1st postoperative day.

Section: Medicine and Dentistrymentioning

confidence: 68%

Evaluation of Pain Syndrome and Efficiency of Pain Management in Lumbar Spine Surgery

Georgiyants

EUREKA: Health Sciences

2019

Ann Otol Rhinol Laryngol

“…23 Additionally, melatonin and pregabalin have been used for anxiolysis and to reduce the stress response in rigid laryngoscopy and intubation. 24,25 However, given the relatively short duration of FL-S, even with stroboscopic examination, nonpharmacological strategies such as salt application to the tongue and/or alternative therapies mentioned above in addition to breathing strategies designed to reduce anxiety may be appropriate in most situations and will be targets for future investigations. 3,26 Approaching the multimodal experience of gag and discomfort in a multidisciplinary manner could significantly improve patient experience during FL.…”

Section: Discussionmentioning

confidence: 99%

Predicting Gag, Discomfort, and Laryngeal Visualization in Patients Undergoing Flexible Laryngoscopy with Stroboscopy

Kiessling

Bayan

Lohse

et al. 2021

Objective: To investigate potential associations between the Predictive Gagging Survey (PGS) with patient experience of gag and discomfort as well as provider perception of patient gag and level of laryngeal visualization during flexible laryngoscopy with stroboscopy (FL-S). Methods: A total of 53 adult patients undergoing FL-S were recruited for this prospective non-controlled study. PGS was completed before FL-S. Patients rated perceived level of gag and discomfort on a 10-point severity scale after FL-S. Additionally, providers completed a Gagging Severity Index (GSI) reflecting their impression of patient gag and level of laryngeal visualization following FL-S. Spearman rank correlation coefficients were used to assess associations. Results: There was a positive association with PGS score and patient perception of gagging (0.34; P = .013) and patient perception of discomfort (0.38; P = .005). No significant association was found between PGS score and provider GSI (−0.12; P = .39) or level of laryngeal visualization (0.15; P = .29). A negative association was found between level of laryngeal visualization and patient perception of gagging (−0.34; P = .012) and discomfort (−0.44; P = .001). No significant differences were found between current and former smokers compared to never smokers for GSI or patient-perceived gag or discomfort. Conclusions: While not predictive of GSI or level of laryngeal visualization, the PGS was found to be a useful tool in predicting patient experience of gagging and discomfort during FL-S, further reinforcing the subjective experience of this procedure. Use of the PGS may be helpful in identifying specific candidates who may struggle with subjective discomfort or gagging during FL-S for future studies considering interventions to manage and meaningfully decrease discomfort. Having such an instrument is important given the low number of individuals who struggle with discomfort during the exam.

“…Whereas the pregabalin, a structural derivative of the inhibitory neurotransmitter γ aminobutyric acid, possesses analgesic, anticonvulsant, anxiolytic, and sleep modulating activities. Pregabalin binds to α 2 δ subunit of voltage sensitive calcium channels and enhance the release of neurotransmitters at the synapses of primary afferent fibers and second-order sensory neurons (7) . It is cost effective and can be administered orally with peak plasma levels reached within an average interval of 54 minutes (8) .…”

Section: Discussionmentioning

confidence: 99%

Attenuation of Hemodynamic Response to Tracheal Intubation with Pregabalin and Dexmedetomidine - A Prospective Randomized Double Blinded Study

Sambandam¹,

Chandrasekran²,

Dhanasekaran³

et al. 2020

jarss

Objective: Airway manipulation during endotracheal intubation is a potential stimulus and it is associated with untoward hemodynamic changes. The aim of this study was to compare the efficacy of intravenous dexmedetomidine and oral pregabalin premedication for attenuation of hemodynamic pressor response to laryngoscopy and intubation. Methods: A total of 60 patients of age group of 18-60 years scheduled for elective surgeries under general anesthesia with ASA physical status I were randomized into two groups. Group D received intravenous dexmedetomidine at a dose of 1 µg kg-1 over 10 minutes before induction and group P received oral pregabalin 150 mg one hour prior to intubation. The primary outcomes, heart rate and mean arterial pressure noted at serial intervals during intubation were compared between the groups. Sedation score was assessed as secondary outcome using Richmond Agitation Sedation Scale Scores (RAAS). Results: Group D and P were comparable with distribution of age, sex and duration of laryngoscopy. The mean heart rates and mean arterial pressures assessed at serial measurements at 0, 1, 3, 5, 10 minutes post-intubation were statistically significant (p=0.005) in dexmedetomidine group when compared to pregabalin group. The RASS scores assessed at 15, 30 and 60 minutes post-extubation were statistically significant (p<0.05) in pregabalin group when compared to dexmedetomidine group. Conclusion: Intravenous dexmedetomidine at a dose of 1 µg kg-1 is more effective than oral pregabalin 150 mg in attenuating hemodynamic response to laryngoscopy and orotracheal intubation. Post-procedural sedation was better achieved with oral pregabalin compared to intravenous dexmedetomidine.