Journal Issue: Volume: 9, No 4, Issue 36, OCT-DEC, 2011
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Volume
Number
Issue Date
2011
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Use of Gabapentin, Esmolol or Their Combination to Attenuate Haemodynamic Response to Laryngoscopy and Intubation
(Kathmandu University, 2011) Shrestha, GS; Marhatta, MN; Amatya, R
ABSTRACT
Background
Laryngoscopy and intubation increases blood pressure and heart rate.
Objective
The study aims to investigate the effect and safety of gabapentin, esmolol or their
combination on the haemodynamic response to laryngoscopy and intubation.
Methods
A total of 72 patients undergoing elective surgery were randomly allocated to one
of the four groups. First study drug was administered orally as gabapentin 1200mg
or placebo. Second study drug was administered intravenously as esmolol 1.5mg/
kg or normal saline. Heart rate, rate pressure product, systolic blood pressure and
mean arterial pressure were recorded at baseline and at zero, one, three and five
minutes after tracheal intubation.
Results
Baseline values were compared with the values at various time intervals within the
same group. In group PE (placebo, esmolol), there was significant decrease in heart
rate and rate pressure product at five minutes. In group GN (gabapentin, normal
saline), there was significant decrease in systolic blood pressure and mean arterial
pressure at five minutes. In group GE (gabapentin, esmolol), there was significant
decrease in heart rate at zero, three and five minutes. Systolic blood pressure, mean
arterial pressure and rate pressure product was significantly lower at three and
five minutes. In group PN (placebo, normal saline), there was significant increase
in heart rate at zero, one, three and five minutes; systolic blood pressure at zero
and one minutes; mean arterial pressure at zero and one minutes & rate pressure
product at zero, one and three minutes. In group GN (gabapentin, normal saline),
there was significant increase in heart rate at zero, one and three minutes & rate
pressure product at zero, one and three minutes. In group PE (placebo, esmolol),
there was significant increase in systolic blood pressure at zero and one minutes &
mean arterial pressure at zero and one minutes. However, in group GE (gabapentin,
esmolol) none of the variables showed statistically significant increase at any time.
Inter-group comparison was made for each time point. At zero minute, there was
significant difference in heart rate between groups PN and GE, GN and PE & GN and
GE Significant difference was also noted in rate pressure product between PN and
GE at zero minute. At one minute there was difference in heart rate between PN
and PE, PN and GE, GN and PE & between GN and GE. Significant difference was
observed in rate pressure product between PN and PE & between PN and GE at one
minute. No significant side effects of the study drugs were observed.
Conclusions
Combination of gabapentin and esmolol in this study design is safe and better
attenuates both the pressor and tachycardic response to laryngoscopy and
intubation, than either agent alone.
KEYWORDS
attenuation of haemodynamic response, Esmolol, Gabapentin, laryngoscopy and
intubation
A Study of Risk Factors of Stroke in Patients Admitted in Manipal Teaching Hospital, Pokhara
(Kathmandu University, 2011) Maskey, A; Parajuli, M; Kohli, S C
ABSTRACT
Background
Stroke is usually end result of predisposing conditions that originated years before
the ictus. Identification of its modifiable risk factors can help in planning preventive
strategies.
Objective
To study the risk factors of stroke in adult patients.
Methods
A hospital based prospective cross sectional study was carried out in 160 stroke
patients admitted in Manipal Teaching Hospital, Pokhara from November 2007-
October 2010. Diagnosis of stroke was confirmed by CT scan of brain. Patients were
then investigated for presence of conventional risk factors. The data was statistically
analysed using Epi-Info.
Results
The mean age of stroke patients was 65.98 years ± 10.69 with 126 (78.8%) of patients
belonging to age group ≥ 60 years. It afflicted higher percentage of males 104
(65%) than females 56 (35%). Analysis of stroke subtypes showed preponderance
of haemorrhagic stroke in 85 (53.1%) as against infarction in 75 (46.9%) of cases.
Other conventional modifiable risk factors were seen as follows: hypertension 98
(61.2 %), cigarette smoking 95 (59.4%), alcohol use 43 (26.9%), left ventricular
hypertrophy 44 (27.5%), atrial fibrillation 37(23%), elevated triglyceride 37(23%),
diabetes mellitus 15 (9.3%) and elevated total cholesterol 12 (7.5%). Multiple risk
factors (≥2) were seen in 122 (76.5 %) cases.
Conclusions
The maximum occurrence of stroke was seen in patients > 60 years. Overall male
preponderance and higher occurrence of haemorrhagic stroke was seen in our
study. Significant risk factors in order of descending order were hypertension,
cigarette smoking, left ventricular hypertrophy, alcohol use, atrial fibrillation and
elevated triglycerides.
KEY WORDS
haemorrhagic stroke, ischaemic stroke, risk factors