Introduction: An increase in blood pressure and heart rate is observed during laryngoscopy and insertion of the endotracheal tube. Melatonin is used for sedation in the Intensive Care Unit. Our study was based on the hypothesis that administrating 3 mg and 6 mg of melatonin 90 minutes before induction attenuates hemodynamic responses encountered during laryngoscopy and intubation.

Materials and Methods: Seventy-five adult patients scheduled for elective surgical procedures, ASA I and II, were assigned into 3 groups (25 patients in each group) to receive oral placebo, melatonin 3 mg, or melatonin 6 mg 90 minutes prior to induction of anesthesia. Hemodynamic variables were recorded at baseline, before induction, and at 3, 6, 9, 12, 15, and 30 minutes after induction. Analysis of variance (ANOVA) was used for intergroup analysis of data. Categorical variables were compared using non-parametric tests like the Chi-square test or Fisher’s exact test. Bonferroni correction was applied for intergroup analysis. Statistical significance was considered when p < 0.05. Results: An increase in heart rate and blood pressure at 3, 6, and 9 minutes after induction of general anesthesia was observed in the control group compared to the melatonin 3 mg and 6 mg groups administered 90 minutes prior to induction. Oral administration of 6 mg of melatonin was found to provide greater attenuation than 3 mg of melatonin.

Conclusion: Oral administration of 3 mg and 6 mg melatonin effectively attenuates the hemodynamic pressor changes observed during laryngoscopy and tracheal intubation.

 

Laryngoscopy, pressor response, melatonin, pre-operative anxiety, hemodynamic changes

 

1. Hajian P, Sharifi S, Nikooseresht M, Moradi A. The effects of intravenous nitroglycerin bolus doses in reducing hemodynamic responses to laryngoscopy and endotracheal intubation. Biomed Res Int. 2021; 3;2021:6694150. doi: 10.1155/2021/6694150.
2. Misganaw A, Sitote M, Jemal S, Melese E, Hune M, Seyoum F, et al. Comparison of intravenous magnesium sulphate and lidocaine for attenuation of cardiovascular response to laryngoscopy and endotracheal intubation in elective surgical patients at Zewditu Memorial Hospital Addis Ababa, Ethiopia. PLoS One. 2021;16(6):e0252465. doi: 10.1371/journal.pone.0252465.
3. Sharma V, Fotedar K, Goel R. Comparison of oral clonidine and gabapentin premedication for attenuation of pressor response to laryngoscopy and endotracheal intubation. Anesth Essays Res. 2020;14(3):412-9. doi: 10.4103/aer.AER_114_20.
4. Friedrich S, Reis S, Meybohm P, Kranke P. Preoperative anxiety. Curr Opin Anaesthesiol. 2022;35(6):674-8. doi: 10.1097/ACO.0000000000001186.
5. Wang R, Huang X, Wang Y, Akbari M. Non-pharmacologic approaches in preoperative anxiety, a comprehensive review. Front Public Health. 2022;10:854673. doi: 10.3389/fpubh.2022.854673.
6. Kruk J, Aboul-Enein BH, Duchnik E. Exercise-induced oxidative stress and melatonin supplementation: current evidence. J Physiol Sci. 2021;71(1):27. doi: 10.1186/s12576-021-00812-2.
7. Gandolfi JV, Di Bernardo APA, Chanes DAV, Martin DF, Joles VB, Amendola CP, et al. The effects of melatonin supplementation on sleep quality and assessment of the serum melatonin in ICU patients: a randomized controlled trial. Crit Care Med. 2020;48(12):e1286-93. doi: 10.1097/CCM.0000000000004690.
8. Jouybar R, Khademi S, Razmjooie S, Bagheri N. Effect of preoperative administration of oral melatonin on pneumatic tourniquet-induced ischemia-reperfusion injury in orthopedic surgery of lower extremities: a randomized clinical trial. Iran J Med Sci. 2022;47(2):123-30. doi: 10.30476/ijms.2021.86960.1701.
9. Gupta P, Jethava D, Choudhary R, Jethava DD. Role of melatonin in attenuation of haemodynamic responses to laryngoscopy and intubation. Indian J Anaesth. 2016;60(10):712-8. doi: 10.4103/0019-5049.191667.
10. Rajan S, Abubaker R, Kala RA, Sasikumar NK, Kannan MV, Kumar L. Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial. J Anaesthesiol Clin Pharmacol. 2023;39(4):596-602. doi: 10.4103/joacp.joacp_159_22.
11. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7. doi: 10.1037//0022-006x.56.6.893.
12. Rose L, Haslam L, Dale C, Knechtel L, McGillion M. Behavioral pain assessment tool for critically ill adults unable to self-report pain. Am J Crit Care. 2013;22(3):246-55. doi: 10.4037/ajcc2013200.
13. Kumar R, Kumari K, Janweja S, Kumar R, Verma M, Sharma A, et al. Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized, controlled, double-blind study. Braz J Anesthesiol. 2023;73(4):434-40. doi: 10.1016/j.bjane.2021.08.011.
14. Abbasivash R, Salimi S, Ahsan B, Moallemi N, Sane S. The effect of melatonin on anxiety and pain of tourniquet in intravenous regional anesthesia. Adv Biomed Res. 2019;8:67. doi: 10.4103/abr.abr_106_19.
15. Rosas-Luna LE, Castelán-Martínez OD, Mora-Magaña I, Ángeles-Castellanos M, Ubaldo-Reyes LM. Midazolam reduction with pre-operative melatonin in abdominal hysterectomy: a double-blind randomized clinical trial. Cir Cir. 2022;90(3):353-8. English. doi: 10.24875/CIRU.20001428..
16. Brignardello-Petersen R. Melatonin probably reduces anxiety in patients undergoing third-molar surgical extractions but maybe not as much as midazolam. J Am Dent Assoc. 2019;150(10):e159. doi: 10.1016/j.adaj.2019.05.013.
17. Yılmaz S, Öner P. Melatonin levels are low in COVID-19 positive patients and these levels are associated with depression, death anxiety and insomnia. Scand J Clin Lab Invest. 2023;83(2):86-94. doi: 10.1080/00365513.2023.2175236.
18. Etedali A, Hosseni AK, Derakhshandeh A, Mehrzad V, Sharifi M, Moghaddas A. melatonin in the management of mood and sleep problems induced by androgen deprivation therapy in prostate cancer patients: a randomized double-blinded, placebo-controlled clinical trial. Iran J Pharm Res. 2022;21(1):e128817. doi: 10.5812/ijpr-128817.
19. Jouybar R, Kazemifar S, Asmarian N, Karami A, Khademi S. Comparison of the effect of melatonin, dexmedetomidine, and gabapentin on reduction of postoperative pain and anxiety following laminectomy: a randomized clinical trial. BMC Anesthesiol. 2022;22(1):318. doi: 10.1186/s12871-022-01851-x.
20. Shahrokhi M, Ghaeli P, Arya P, Shakiba A, Noormandi A, Soleimani M, et al. Comparing the effects of melatonin and zolpidem on sleep quality, depression, and anxiety in patients with colorectal cancer undergoing chemotherapy. Basic Clin Neurosci. 2021;12(1):105-14. doi: 10.32598/bcn.12.1.1650.2.
21. Sane S, Motarjemizadeh Q, Komilzhonovich IN, Abdelbasset WK, Zaman GS, Suksatan W,et al. The effect of melatonin on analgesia, anxiety, and intraocular pressure (IOP) in cataract surgery under topical anesthesia. J Perianesth Nurs. 2023;38(2):253-7. doi: 10.1016/j.jopan.2022.05.081.
22. Kiabi FH, Emadi SA, Jamkhaneh AE, Aezzi G, Ahmadi NS. Effects of preoperative melatonin on postoperative pain following cesarean section: A randomized clinical trial. Ann Med Surg (Lond). 2021;66:102345. doi: 10.1016/j.amsu.2021.102345.
23. Javaherforooshzadeh F, Amipour I, Janatmakan F, Soltanzadeh M. Comparison of effects of melatonin and gabapentin on post operative anxiety and pain in lumbar spine surgery: A randomized clinical trial. Anaesth Pain Med 2018;8(3):e68763. doi: 10.5812/aapm.68763.
24. Mowafi HA, Ismail SA. Melatonin improves tourniquet tolerance and enhances postoperative analgesia in patients receiving intravenous regional anaesthesia. Anesth Analg. 2008;107(4):1422-6. doi: 10.1213/ane.0b013e318181f689.