Tehran University Medical Journal

Background: Tracheal intubation and direct laryngoscopy are powerful noxious stimuli that can elicit sever hemodynamic responses. These hemodynamic responses should be attenuated by appropriate use of premedication, smooth induction of anesthesia and rapid tracheal intubation. Gabapentin and pregabalin have been suggested in several studies to be efficient. Gabapentin is an antiepileptic drug and a structural analogue of gamma-Aminobutyric acid (GABA) but it does not act through GABA receptors and pregabalin, is also an antiepileptic agent. The aim of this study was to compare the effect of gabapentin and pregabalin as premedication for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation.
Methods: In a prospective double blinded randomized clinical trial, during April 2015 to March 2016 in Urmia Imam Khomeini Hospital, a total of ninety normotensive adult consented patients, candidate to elective abdominal surgery aged 20-50 years, American Society of Anesthesiologist (ASA) class I, of both gender were randomized into three groups. Patients in group I received oral placebo, group II received oral gabapentin 900 mg and group III patients received oral pregabalin 150 mg two hours prior to induction of anesthesia. Anesthetic technique was same in three groups and all groups were assessed for hemodynamic changes such as heart rate, systolic blood pressure and diastolic blood pressure, after the premedication, before and after induction of anesthesia, and 1, 3 and 5 minutes. after laryngoscopy and tracheal intubation.
Results: Significant increase in heart rate and systolic blood pressure and diastolic arterial pressure was observed in placebo group after tracheal intubation, while statistically significant attenuation of hemodynamic changes was seen in gabapentin and pregabalin groups. (P=0.001) No adverse outcome was reported in the study groups.
Conclusion: Oral gabapentin premedication is effective for control of hemodynamic pressor response of laryngoscopy and tracheal intubation. The study data showed that the pregabalin have the same effect. Pregabalin and gabapentin are both useful and safe for control of hemodynamic pressor response as premedication.

Background: Suicide is one of the main health problems in different societies and is associated with different risk factors. The result of a suicide attempt is directly related to the selected method. Invasive suicides are known as violent methods of self-harm and are usually happened in different patterns of age and gender. The aim of this study was to investigate the outcome and varieties of suicide via invasive methods in a long-term period in Ilam province, Iran.
Methods: In this retrospective study, the required data, including demographic variables, outcomes and the kind of invasive method was extracted from a comprehensive registration system of suicide cases, recorded by Ilam University of Medical Sciences (IUMS), to investigate the invasive suicides during the 1993-2013 years. The study was approved by the Ethics Committee of Ilam University of Medical Sciences and based on this approval the permission to access the suicide data was issued. Data were entered into the SPSS 20 software (SPSS Inc., Chicago, IL, USA) and using descriptive statistical methods and chi-square were analyzed based on completed or attempted outcome of suicide.
Results: Among a total of 1516 cases of invasive suicide, 643 (42.6%) were attempted and 867 (57.4%) were completed suicides. Self-immolation method showed the highest frequency of suicide (both completed and attempted). The highest frequency of completed suicide was occurred in females (52.8%) but the attempted suicide was higher in males (63.6%). The age groups of 25-34 years and above 65 years indicated the highest frequencies of attempted and completed suicides respectively.
Conclusion: One of the main objectives of this study was identification of high risk groups who used the invasive methods for suicide commitments, based on their epidemiological characteristics such as gender and age. The results showed that women and elderly individuals were among the high-risk groups who committed completed suicide using the invasive methods and self-immolation attributed the most frequent method among invasive methods for suicide in Ilam province which resulted in death.