Gabapentin Premedication Decreases the Hemodynamic Response to Skull Pin Insertion in Patients Undergoing Craniotomy

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dc.contributorMisra, Satyajeet
dc.contributorKoshy, Thomas
dc.contributorUnnikrishnan, Koniparambil Pappu
dc.contributorSuneel, Puthuvassery Raman
dc.contributorChatterjee, Nilay
dc.date.accessioned2012-12-04T11:44:10Z
dc.date.available2012-12-04T11:44:10Z
dc.date.issued2011
dc.description.abstractBackground: 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.
dc.identifier.citationJOURNAL OF NEUROSURGICAL ANESTHESIOLOGY. 23; 2; 110-117en_US
dc.identifier.urihttp://dx.doi.org/10.1097/ANA.0b013e3181da3c3b
dc.identifier.urihttp://www.ncbi.nlm.nih.gov/pubmed/20479668
dc.identifier.urihttps://dspace.sctimst.ac.in/handle/123456789/530
dc.publisherJOURNAL OF NEUROSURGICAL ANESTHESIOLOGY
dc.subjectNeurosurgery
dc.titleGabapentin Premedication Decreases the Hemodynamic Response to Skull Pin Insertion in Patients Undergoing Craniotomy
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