الفهرس 
Nerve Supply of the AirwayOnly 14 pages are availabe for public view
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Abstract
Cardiovascular response to laryngoscopy and
endotracheal intubation is well known and is linked to increases
in catecholamine blood levels. Many studies proved that
pregabalin is effective in attenuating the stress response to
laryngosopy and intubation. Surgical patients commonly
develop hyperglycemia related to the hypermetabolic stress
response, which increases glucose production and causes
insulin resistance.
Surgery causes postoperative pain that should be
alleviated as soon and as effective as possible to reduce
suffering, to promote healing process and rehabilitation and to
prevent complications. Preemptive analgesia prevents (or
reduces) pathologic pain that is different from physiologic pain
in several aspects; it is excessive in intensity and spread and
can be activated by low-intensity stimuli. The preventive
analgesic role of pregabalin in postoperative pain is well
documented. Pregabalin also has a role in neuropathic pain
states such as postspinal cord injury, post-traumatic peripheral
neuropathy and failed back surgery syndrome.
The aim of this work was to evaluate the effects of
different doses of pregabalin as an oral premedication to
attenuate cardiovascular response during laryngoscopy and
endotracheal intubation. Intubation-induced hyperglycemia was
also assessed in addition to the effect of the drug on postoperative analgesia in normotensive normoglycemic
patients undergoing abdominal hysterectomy.
The study included 120 patients who were randomly
divided into 4 equal groups; group A received a placebo drug
and groups B,C and D received different doses of oral
pregabalin(75 mg, 150 mg and 300 mg respectively). The
patients were unaware of their group distribution. Patients were
carefully selected regarding the demographic data and the
medical status.
The anesthetic technique included preoperative
assessment and preparation during which the patients were
informed about the details of the study, gave their consent,
learned how to use VAS, and received the drug of the study. A
standard intraoperative anesthetic technique was done and
study parameters were observed and recorded. The study was
completed for 90 minutes in PACU and continued for 36 hours
postoperatively.
Intraopratively, duration of endotracheal intubation and
surgery were recorded for each patient. Hemodynmic
parameters (SBP, DBP, MBP, and HR) and blood glucose
levels were assessed according to specific schedules and were
compared between groups as well as with preoperative baseline
values. Total consumption of intraoperative fentanyl was also
calculated.
Postoperatively, sedation was scored twice and time to
first request of analgesia was recorded. Consumption of pethidine was calculated for each patient in the first 36 hours
postoperatively. Observation of the patients for occurrence of
side effects or complications of drugs or surgery was done.
There was no significant difference between groups as
regards demographic data, duration of intubation or duration of
surgery. There was increase in hemodynamic values during
intubation compared to the baseline values in all groups.
However, the increase in both groups C and D was less than
that of groups A and B. Afterwards, there was a gradual
decrease in the hemodynamic parameters at 2, 4 and 6 minutes
after intubation in all groups. This proved the definite role of
pregabalin in doses of 150 and 300 mg in attenuating the
hemodynamic response to laryngoscopy and endotracheal
intubation.
The present study could not prove the efficacy of
pregabalin in different doses in decreasing the hyperglycemic
response to laryngoscopy and intubation.
Intraoperative fentanyl consumption decreased in the
current study on using pregabalin in doses of 150 mg and 300
mg. A dose of 75 mg did not show such effect. Moreover, the
study revealed that a dose of 300 mg pregabalin did not differ
from a dose of 150 mg as regards reduction of intraoperative
fentanyl consumption.
At 30 minutes after arrival to PACU, group D (300 mg
pregabalin) had the largest number of sedated patients (12 patients) followed by group C (4 patients).None of the patients
in groups A and B was sedated. This indicated a consistent
sedating effect of pregabalin with increasing the dose.
Times to first request of analgesia in PACU were
significantly prolonged in groups C and D (150 mg and 300 mg
pregabalin respectively) compared to groups A and B (placebo
and 75 mg respectively). They were three to five times longer.
This result indicated the potent analgesic effect of pregabalin.
In the current study, the total amount of consumed pethidine
during 36 hours postoperatively was significantly reduced on
using pregabalin in doses of 150 mg and 300 mg compared to
the dose of 75 mg. This result was a further indication of the
analgesic effect of pregabalin.
There were no postoperative surgical complications in any
patient. Sedation was the only adverse effects of pregabalin in
some patients. No other adverse effects were noticed. Nausea
occurred in all groups. Although the number of patients who
had nausea in groups C and D was less than that in groups A
and B, yet there was no statistical significant difference
between groups. The lower incidence of nausea in groups C and
D might be attributed to the opioid-sparing effect.