Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial
A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4, respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG.
Kong VK, Irwin MG. Gabapentin: a multimodal perioperative drug? Br J Anaesth 2007;99(6):775-86.
Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 2003;290(18):2455-63.
Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth 1996;8(1):63-79.
Backonja M, Beydoun A, Edwards KR. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998;280(21):1831-6.
Donovan-Rodriguez T, Dickenson AH, Urch CE. Gabapentin normalizes spinal neuronal responses that correlate with behavior in a rat model of cancer-induced bone pain. Anesthesiology 2005;102(1):132-40.
Gottrup H, Juhl G, Kristensen AD, et al. Chronic oral gabapentin reduces elements of central sensitization in human experimental hyperalgesia. Anesthesiology 2004;101(6):1400-8.
Guttuso T Jr, Roscoe J, Griggs J. Effect of gabapentin on nausea induced by chemotherapy in patients with breast cancer. Lancet 2003;361(9370):1703-5.
Nicholson B. Gabapentin uses in neuropathic pain syndromes. Acta Neurol Scand 2000;101(6):359-71.
Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998;280(21):1837-42.
Sarantopoulos C, McCallum B, Kwok WM, et al. Gabapentin decreases membrane calcium currents in injured as well as in control mammalian primary afferent neurons. Reg Anesth Pain Med 2002;27(1):47-57.
Bafna U, Goyal VK, Garg A. A comparison of different doses of gabapentin to attenuate the hemodynamic response to laryngoscopy and tracheal intubation in normotensive patients. J Anaesthesiol Clin Pharmacol 2011;27(1):43-6.
Bartholdy J, Hilsted KL, Hjortsoe NC, et al. Effect of gabapentin on morphine demand and pain after laparoscopic sterilization using Filshie clips. A double blind randomized clinical trial. BMC Anesthesiol 2006;6(1):12.
Kaya FN, Yavascaoglu B, Baykara M, et al. Effect of oral gabapentin on the intraocular pressure and haemodynamic responses induced by tracheal intubation. Acta Anaesthesiol Scand 2008;52(8):1076-80.
Memiş D, Turan A, Karamanlioğlu B, et al. Gabapentin reduces cardiovascular responses to laryngoscopy and tracheal intubation. Eur J Anaesthesiol 2006;23(8):686-90.
Ali AA, Elnakera AM, Samir A. Effect of Two Different Doses of Gabapentin on the Intraocular Pressure and Hemodynamic Stress Responses to Laryngoscopy and Tracheal Intubation. Hindawi. (Accessed in May 2015, 10, at
Fox EJ, Sklar GS, Hill CH, et al. Complications related to the pressure response to endotracheal intubation. Anesthesiology 1977;47:524-5.
Prys-roberts C, Greene LT, Meloche R, et al. Studies of anaesthesia in relation to hypertension. II: Hemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971;43(6):531-47.
Fassoulaki A, Melemeni A, Paraskeva A, et al. Gabapentin attenuates the pressor response to direct laryngoscopy and tracheal intubation. Br J Anaesth 2006;96(6):769-73.
Koc S, Memis D, Sut N. The preoperative use of gabapentin, dexamethasone, and their combination in varicocele surgery: a randomized controlled trial. Anesth Analg 2007;105(4):1137-42.
Partridge BJ, Chaplan SR, Sakamoto E, et al. Characterization of the effects of gabapentin and 3- isobutyl-gamma-aminobutyric acid on substance P-induced thermal hyperalgesia. Anesthesiology 1998;88(1):196-205.
Yoon MH, Yaksh TL. The effect of intrathecal gabapentin on pain behavior and hemodynamics on the formalin test in the rat. Anesth Analg 1999;89(2):434-9.
Gee NS, Brown JP, Dissanayake VU. The novel anticonvulsant drug,gabapentin, binds to alpha 2 delta subunit of calcium channel. J Biol Chem 1996;271(10):5768-76.
Finfer SR, MacKenzie SI, Saddler JM, et al. Cardiovascular responses to tracheal intubation: a comparison of direct laryngoscopy and fibreoptic intubation. Anaesth Intensive Care 1989;17(1):44-8.
Montazeri K, Kashefi P, Honarmand A, et al. Attenuation of the pressor response to direct laryngoscopy and tracheal Intubation: oral clonidine vs. oral gabapentin premedication. J Res Med Sci 2011;16(Suppl 1):377-86.
Me´nigaux C, Adam F, Guignard B, et al. Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesth Analg 2005;100(6):1394-9.