Kapse Upendra Kumar S, Bhalerao Pradnya Milind
Department of Anaesthesiology and Critical Care, B.J. Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India.
Anesth Essays Res. 2016 Jan-Apr;10(1):17-22. doi: 10.4103/0259-1162.164732.
Pressor response is a part of stress response caused by reflex sympathetic discharge due to direct laryngoscopy and tracheal intubation resulting in tachycardia, hypertension and arrhythmias. Both clonidine, and gabapentin administered orally can effectively blunt this detrimental hemodynamic response.
To study the effect of oral clonidine to blunt the pressor response to direct laryngoscopy and to compare it with oral gabapentin. To observe for postoperative sedation and side effects if any.
Sixty patients of American Society of Anaesthesiologist Grade I and II scheduled for surgery under general anesthesia were considered in this prospective randomized double-blind study. They were randomly allocated into two groups of 30 each using computerized randomization.
Group A was given oral clonidine 5 μg/kg and Group B was given oral gabapentin 800 mg. Both the drugs were given 90 min prior to surgery. Heart rate (HR) and blood pressure were monitored at baseline, 0, 1, 3, 5, 10, 15, and 30(th) min of laryngoscopy. Sedation was monitored by Ramsay Sedation Scale score and side effects were noted.
HR decreased in both groups at 0 and 1 min, increased at 3(rd) min and gradually decreased by 30(th) min. Statistically, significant difference was found between two groups at 1, 3, 5, 10, and 15(th) min (P < 0.05). Though there was no significant difference in systolic blood pressure, diastolic blood pressure and mean arterial pressure between the two groups, there was no rise in these parameters. Gabapentin produced more sedation than clonidine postoperatively, and few side effects were noted.
Both oral clonidine and gabapentin are effective in obtunding pressor response to direct laryngoscopy, clonidine being better in terms of controlling HR. Gabapentin produces more postoperative sedation than clonidine.
升压反应是直接喉镜检查和气管插管引起的反射性交感神经放电所导致的应激反应的一部分，会引起心动过速、高血压和心律失常。口服可乐定和加巴喷丁均可有效减轻这种有害的血流动力学反应。
研究口服可乐定减轻直接喉镜检查升压反应的效果，并与口服加巴喷丁进行比较。观察术后镇静情况及有无副作用。
本前瞻性随机双盲研究纳入了60例美国麻醉医师协会I级和II级、计划接受全身麻醉手术的患者。使用计算机随机化将他们随机分为两组，每组30例。
A组口服可乐定5μg/kg，B组口服加巴喷丁800mg。两种药物均在手术前90分钟给药。在喉镜检查的基线、0、1、3、5、10、15和30分钟监测心率（HR）和血压。通过拉姆齐镇静评分监测镇静情况，并记录副作用。
两组在0和1分钟时HR均下降，在第3分钟时升高，并在第30分钟时逐渐下降。统计学上，两组在第1、3、5、10和15分钟时存在显著差异（P<0.05）。虽然两组之间的收缩压、舒张压和平均动脉压没有显著差异，但这些参数没有升高。加巴喷丁术后产生的镇静作用比可乐定更强，且副作用较少。
口服可乐定和加巴喷丁均可有效减轻直接喉镜检查的升压反应，可乐定在控制心率方面更好。加巴喷丁术后产生的镇静作用比可乐定更强。
