|Author||Misra, Satyajeet ♦ Koshy, Thomas ♦ Unnikrishnan, K. P. ♦ Suneel, Puthuvassery Raman ♦ Chatterjee, Nilay|
|Source||Sree Chitra Tirunal Institute for Medical Sciences & Technology|
|Publisher||Journal of Neurosurgical Anesthesiology|
|Subject Domain (in DDC)||Technology ♦ Medicine & health ♦ Surgery & related medical specialties|
|Subject Domain (in MeSH)||Nervous System Diseases ♦ Diseases ♦ Surgical Procedures, Operative ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment|
|Abstract||Background: In patients undergoing craniotomy, skull pin insertion produces significant increases in heart rate (HR) and blood pressure. We investigated whether premedication with gabapentin would prevent or attenuate this increase.Methods: Forty-seven ASA I and II patients, 18 to 60 years, undergoing elective craniotomy for intracranial tumor surgery were recruited prospectively and randomly divided into 3 groups; L (oral placebo plus 2% lidocaine infiltration at pin sites; n = 12), G (oral gabapentin 900 mg plus normal saline infiltration; n = 21) and GL (oral gabapentin 900mg plus 2% lidocaine infiltration; n = 14). The oral medications were administered 2 hours before induction of anesthesia. Measurements were made at preinduction baseline, before skull pin insertion and at every 1 minute from pin insertion till end of 10 minutes.Results: Forty-three patients completed the study (L, n = 11; G, n = 20; GL, n = 12). Premedication with gabapentin significantly attenuated the rise in systolic (SBP) and mean arterial pressure (MAP) after pin insertion when compared with placebo (for SBP, P < 0.001 at 1 and 2 min and < 0.05 at 3 to 5 min between L and G; P < 0.001 at 1 to 4 min and < 0.05 at 5 min between L and GL; for MAP, P < 0.05 at 1 min, < 0.001 at 2 min and < 0.05 at 3 to 4 min between L and G; P < 0.001 at 1 to 2 min and < 0.05 at 3 to 5 min between L and GL). HR responses were also attenuated in patients premedicated with gabapentin; however, the responses were more variable in group G (P = 0.03 between L and G at 4 min after pin insertion) as compared with group GL (P < 0.05 at 1 min, < 0.001 at 2 min and < 0.05 at 3 to 10 min between L and GL).Conclusion: In conclusion, 900mg of gabapentin, administered orally 2 hours before induction of anesthesia along with lidocaine scalp infiltration abolished the hemodynamic response after skull pin insertion. Premedication with gabapentin alone significantly attenuated the SBP and MAP; however, HR responses were more variable. A larger trial is required to corroborate the findings of the study before clinical recommendations would be warranted.|
|Education Level||UG and PG|
|Learning Resource Type||Article|
|Educational Framework||Medical Council of India (MCI)|
|Journal||JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY|
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