A comparative study of effect of pre-treatment with oral Gabapentin versus Melatonin versus Clonidine on hemodynamic response to laryngoscopy and tracheal intubation in controlled hypertensive patients: A double-blinded, randomized controlled study.

Title of the study: 

A comparative study of effect of pre-treatment with oral Gabapentin versus Melatonin versus Clonidine on hemodynamic response to laryngoscopy and tracheal intubation in controlled hypertensive patients: A double-blinded, randomized controlled study.

Background:

Direct laryngoscopy and endotracheal intubation cause a reflex sympathetic response that leads to increased heart rate, blood pressure, and risk of arrhythmias. This response usually peaks within one to two minutes and settles by five to six minutes, though tachycardia may last up to ten minutes. Hypertensive patients are more vulnerable due to their higher risk of heart and brain vessel diseases. Gabapentin, originally used for epilepsy and neuropathic pain, may reduce this response possibly through calcium channel modulation. Melatonin, a natural hormone with sedative and anxiolytic effects, has also been shown to reduce cardiovascular changes during intubation. Clonidine, a drug for high blood pressure with central sympatholytic effects, can similarly blunt the hemodynamic response when given as premedication.

Justification of the study:

Various drugs like calcium channel blockers, beta blockers, and opioids have been used to reduce the hemodynamic response to laryngoscopy and intubation to prevent complications such as myocardial ischemia and cerebral hemorrhage. Recently, clonidine, gabapentin, and melatonin have been studied for this purpose. This study aims to compare their effectiveness in attenuating the pressor response in treated hypertensive patients, a group for which limited data is available.

Objective:

This study aims to compare the effectiveness of Gabapentin, Melatonin, and Clonidine in blunting the hemodynamic response to laryngoscopy and intubation in treated hypertensive patients. In addition to evaluating the primary outcome, the study will also assess patients’ anxiety levels prior to induction and monitor for any side effects associated with the use of these study drugs.

Methodology:

In this study, eligible patients who provided consent were randomized and allocated into three groups. Each group received pretreatment one hour before induction: Group A was given oral Gabapentin 300 mg, Group B received oral Melatonin 3 mg, and Group C was administered oral Clonidine 100 mcg. Following pretreatment, all patients underwent laryngoscopy and endotracheal intubation. Patients who required multiple intubation attempts or had an intubation time exceeding 30 seconds were excluded from the study. Data from the remaining participants were collected and subjected to statistical analysis.