Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

Doleman, Brett; Sherwin, Matthew; Lund, Jonathan N.; Williams, John P.

Abstract

Purpose

Endotracheal intubation is the gold standard for securing the airway before surgery. Nevertheless, this procedure can produce an activation of the sympathetic nervous system and result in a hemodynamic response which, in high-risk patients, may lead to cardiovascular instability and myocardial ischemia. The aim of this review was to evaluate whether gabapentin can attenuate this response and whether such an attenuation could translate into reduced myocardial ischemia and mortality.

Source

We searched MEDLINE®, EMBASE™, CINAHL, AMED, and unpublished clinical trial databases for randomized-controlled trials that compared gabapentin with control, fentanyl, clonidine, or beta blockers for attenuating the hemodynamic response to intubation. Primary outcomes were mortality, myocardial infarction, and myocardial ischemia. Secondary outcomes were hemodynamic changes following intubation.

Principal findings

We included 29 randomized trials with only two studies at low risk of bias. No data were provided for the primary outcomes and no studies included high-risk patients. The use of gabapentin resulted in attenuation in the rise in mean arterial blood pressure [mean difference (MD), −12 mmHg; 95% confidence interval (CI), −17 to −8] and heart rate (MD, −8 beats·min−1; 95% CI, −11 to −5) one minute after intubation. Gabapentin also reduced the risk of hypertension or tachycardia requiring treatment (risk ratio, 0.15; 95% CI, 0.05 to 0.48). Data were limited on adverse hemodynamic events such as bradycardia and hypotension.

Conclusion

It remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations.

Citation

Doleman, B., Sherwin, M., Lund, J. N., & Williams, J. P. (in press). Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis. Canadian Journal of Anesthesia / Journal canadien d'anesthésie, 63(9), https://doi.org/10.1007/s12630-016-0668-0

• Journal Article Type: Article
• Acceptance Date: May 6, 2016
• Online Publication Date: May 20, 2016
• Deposit Date: Feb 1, 2017
• Publicly Available Date: Feb 1, 2017
• Journal: Canadian Journal of Anesthesia
• Print ISSN: 0832-610X
• Electronic ISSN: 1496-8975
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 63
• Issue: 9
• DOI: https://doi.org/10.1007/s12630-016-0668-0
• Public URL: https://nottingham-repository.worktribe.com/output/789149
• Publisher URL: http://link.springer.com/article/10.1007%2Fs12630-016-0668-0
• Contract Date: Feb 1, 2017