Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized controlled double blind study
Papel da melatonina na atenuação da resposta hemodinâmica à intubação e necessidades anestésicas: um estudo randomizado, controlado e duplo-cego
Rakesh Kumar, Kamlesh Kumari, Sarita Janweja, Rakesh Kumar, Manoj Verma, Ankur Sharma, Bharat Paliwal, Rama Kishan
Abstract
Background
Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements.
Methods
Sixty-four patients scheduled for laparoscopic cholecystectomy were randomized into melatonin or placebo group (n = 32 each). Melatonin group received two tablets (3 mg each) of melatonin, and the placebo group received two tablets of vitamin D3 120 min before induction. Hemodynamic parameters were recorded during induction and postintubation for 15 minutes. Total induction dose of propofol, total intraoperative fentanyl consumption, and adverse effects of melatonin were also noted.
Results
Postintubation rise in heart rate (HR) was less in the melatonin group compared to the placebo group (10.59% vs. 37.08% at 1 min, respectively) (p < 0.0001). Maximum percentage increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was lesser in melatonin group than placebo group (SBP 9.25% vs. 37.73%, DBP 10.58% vs. 35.51%, MBP 9.99% vs. 36.45% at 1 min postintubation. respectively) (p < 0.0001). Induction dose of propofol (1.42 mg.kg-1 vs. 2.01 mg.kg-1) and the number of patients requiring additional fentanyl intraoperatively (3 vs. 11) were also significantly reduced in the melatonin group.
Conclusion
Premedication with 6 mg of oral melatonin resulted in significant attenuation of postintubation rise in HR, SBP, DBP, and MBP. It also reduced the induction dose of propofol, total intraoperative fentanyl consumption without any adverse effects.
Keywords
Resumo
Introdução
A melatonina tem sido estudada para ter efeitos ansiolíticos, sedativos e analgésicos. No entanto, existem dados limitados sobre o efeito da melatonina na atenuação da resposta hemodinâmica à intubação. Nosso objetivo foi estudar se a melatonina oral pré-anestésica atenua as respostas hemodinâmicas à intubação e aos requisitos anestésicos.
Métodos
Sessenta e quatro pacientes agendados para colecistectomia laparoscópica foram randomizados em grupo de melatonina ou placebo (n = 32 cada). O grupo melatonina recebeu dois comprimidos (3mg cada) de melatonina, e o grupo placebo recebeu dois comprimidos de vitamina D3 120min antes da indução. Os parâmetros hemodinâmicos foram registrados durante a indução e pós-intubação por 15 minutos. Dose total de indução de propofol, consumo intraoperatório total de fentanil e efeitos adversos da melatonina também foram observados.
Resultados
O aumento pós-intubação na frequência cardíaca (FC) foi menor no grupo melatonina em comparação com o grupo placebo (10,59% vs. 37,08% em 1min, respectivamente) (p<0,0001). O aumento percentual máximo na pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e pressão arterial média (PAM) foi menor no grupo melatonina do que no grupo placebo (PAS 9,25% vs. 37,73%, PAD 10,58% vs. 35,51%, PAM 9,99% vs. 36,45% em 1 min pós-intubação, respectivamente) (p < 0,0001). A dose de indução de propofol (1,42 mg.kg-1 vs. 2,01mg.kg-1) e o número de pacientes que necessitaram de fentanil adicional no intraoperatório (3 vs. 11) também foram significativamente reduzidos no grupo melatonina.
Conclusão
A pré-medicação com 6 mg de melatonina oral resultou em atenuação significativa do aumento pós-intubação da FC, PAS, PAD e PAM. Também reduziu a dose de indução de propofol, o consumo intraoperatório total de fentanil sem quaisquer efeitos adversos.
Palavras-chave
References
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