Attenuation of hemodynamic pressor response to laryngoscopy and endotracheal intubation by intravenous fentanyl in elective surgery under general anesthesia: A randomized controlled trial using three different doses (original) (raw)
Related papers
2014
Background: Laryngoscopy and endotracheal intubation are integral part of induction of general anesthesia which cause to presser response leading to hemodynamic responses. Several techniques have been studied to attenuate this stress response but none of them are completely satisfactory hence there is a constant search for an ideal drug to attenuate hemodynamic response. Here we studied the hemodynamic response to laryngoscopy and endotracheal intubation and compare the relative efficacy of Esmolol and Fentanyl for attenuation of hemodynamic response during laryngoscopy and endotracheal intubation. Methods: After obtaining approval from the Institutional Ethics Committee and written informed consent form patients, 60 patients were randomly selected & allocated into two groups,Group I:Esmolol group &Group II: Fentanyl group of 30 each.Vital parameters (pulse rate and blood pressure) were measured at various intervals and compared. Multiple pair wise comparisons with Bonferroni’s adju...
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Laryngoscopy and intubation result in stimulation of larynx, pharynx, epipharynx and trachea, which are extensively innervated by autonomic nervous system. The parasympathetic supply is via the vagus and sympathetic supply via superior cervical ganglion. To diminish hemodynamic responses to tracheal intubation, Fentanyl along with hypnotic agents commonly used. Keeping in mind, an attempt has been made to assess the efficacy of injection fentanyl for attenuation of sympathetic response to intubation. Aims and objective: To assess efficacy of 2microgram/kg body weight fentanyl and 3 microgram/kg body weight fentanyl administered before laryngoscopy and endotracheal intubation for attenuation of hemodynamicresponse. Materials and Methods: 90 normotensive adult patients, belonging to ASA physical status I, of either sex, age group of 18-65 years, free from inter current cardiovascular and neurological disease, were posted for elective surgical procedures under general anaesthesia requiring orotracheal intubation were selected. All were elective cases. Three groups were made. Group I-Control group-10 cc normal saline IV. Group II- 2microgram/kg body weight fentanyl IV diluted to 10 cc with Distillate Water (DW). Group III- 3 microgram/kg body weight fentanyl IV diluted to 10 cc with D.W. Each group comprised of 30 patients. Result: The rise in pulse rate in both the fentanyl groups, was less and statistically significant than control group (p<0> Conclusion: Use of intravenous fentanyl in both doses, i.e. 2 mcg/kg as well as 3 mcg/kg is safe and effective for attenuation of hemodynamic response to laryngoscopy and intubation. Keywords: Fentanyl, Intubation, Laryngoscopy, Hemodynamic.
Zenodo (CERN European Organization for Nuclear Research), 2023
Endotracheal intubation elicits huge spectrum of stress responses which are hazardous in high-risk patients. Numerous drugs and techniques have been applied to attenuate the stress responses. In this double-blind study, one hundred and forty-five patients over 20 years old, ASA physical status I and II, undergoing elective surgeries requiring general anaesthesia with endotracheal intubation were included. Patients were randomly divided into three groups which fentanyl 2 mcg/kg was given at either 1, 2, 3 minutes before intubation. All groups received midazolam 0.05 mg/kg, lidocaine 0.5 mg/ kg, propofol 2 mg/kg and rocuronium 1 mg/kg before intubation. Haemodynamic parameters were recorded for 10 minutes after induction. Two-level longitudinal hierarchical linear models were used for data interpretation and P < 0.05 was considered statistically significant. The study demonstrated significantly lower haemodynamic responses in the group who received fentanyl 2 minutes before intubation (p < 0.05). Confounding factors such as smoking, hypertension, diabetes mellitus and preoperative intravenous fluid supplement were analysed. In conclusion, fentanyl injection 2 minutes before intubation is recommended in order to obtain the most stable haemodynamic status.
Journal of Medical Society, 2015
Background and Aims: Alpha-2 agonists are being increasingly used as adjuncts in general anesthesia and the present study was carried out to study the effect of clonidine as an adjuvant to low dose fentanyl in attenuating the hemodynamic response to laryngoscopy and orotracheal intubation. Materials and Methods: Ninety female patients belonging to American Society of Anesthesiologists (ASA) physical status I, II, and III in age group 25-65 years, body mass index (BMI) 21-26 kg/m 2 , and diagnosed as carcinoma breast scheduled for breast surgery were included in this Prospective, randomized, placebo-controlled study. One-way analysis of variance (ANOVA), paired t-test, and chi-square test was applied where deemed appropriate. P-value at or below the level of 0.05 was considered as statistically significant. Results: Intravenous (IV) clonidine 1.0 μg kg-1 and clonidine 2.0 μg kg-1 significantly attenuated the hyperdynamic response to laryngoscopy and intubation. Clonidine 2.0 μg kg-1 was associated with adverse effects like hypotension at the time of induction and postoperative sedation which was not observed with clonidine 1.0 μg kg-1. Conclusions: A single intravenous low dose clonidine (1.0 μg kg-1) when combined with low dose fentanyl (2 μg kg-1) is a practical, pharmacological and safe method with minimal side effects to attenuate the hyperdynamic response to laryngoscopy and intubation.
Medical Archives, 2014
Introduction: Endotracheal intubation is one of the most invasive stimuli in anesthesia and it's often accompanied by a hemodynamic pressor response. Th e purpose of this study was to investigate the effi cacy of a single pre-induction 2 μg/kg bolus injection of fentanyl followed by two puff s of nitroglycerin sub lingual spray (400 μg /spray) with a thiopentone/suxamethonium sequence in the attenuation of the hemodynamic response to endotracheal intubation in normotensive patients. Material and methods: Th e study consisted of 80 randomly selected ASA physical status I/II male/female adults who were aged between 18 through 60 years and scheduled for elective surgery. Group I received a single 2 μg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy followed by two puff s of nitroglycerin sub lingual spray (400 μg/spray) 2 minutes prior to intubation (n=40). Group II received a single 2 μg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy (n=40). Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product were compared to basal values at pre-induction, induction, intubation and post-intubation as well as at time increments of 1, 3, 5, 7 and 10 min. Results: Fentanyl combined with nitroglycerin did not attenuate hemodynamic pressor responses more than fentanyl alone. Increases of HR (7.9%), DBP (4.0%), MAP (3.6%) and RPP (6.0%) along with attenuation of SBP (2.7%) were observed in the fentanyl-nitroglycerin group as compared to the equivalent control measured values. Conclusions: A single pre-induction bolus injection of fentanyl followed by two puff s of nitroglycerin sub lingual spray in a thiopentone/suxamethonium anesthetic sequence neither successfully attenuates nor successfully suppresses the hemodynamic pressor response more eff ectively than fentanyl alone in normotensive patients resulting from endotracheal intubation.
ATTENUATION OF HAEMODYNAMIC RESPONSE DURING LARYNGOSCOPIC INTUBATION WITH FENTANYL
National Journal of Medical Research, 2016
Introduction: Identified as a depth-of-anesthesia-dependent influencing factor, endotracheal intubation has been suggested to be one of the most invasive stimuli in anesthesia, particularly during induction3 and after tracheal intubation. The objective of the study was to find a safe and effective means of attenuating the cardiovascular response to laryngoscopy and tracheal intubation. Methodology: S.A.L Hospital and Medical institute and KESAR SAL Medical College and Research Institute, Ahmedabad during 2008-2010 in 100 patients, divided in two groups having 50 patients in each group. One group received intravenous fentanyl while other group termed as control group received intravenous normal saline. The following hemodynamic variables were considered for study: changes in heart rate and comparison of the controlled group with the group who received fentanyl; & changes in systolic arterial pressure and diastolic arterial pressure in the fentanyl treated group in comparison to the control group. Results: At induction both the groups were observed to have a 5% decrease in heart rate in comparison to basal levels. At intubation, however, the fentanyl group had a highly significant mean heart rate at 12% below the control group (P≤0.0001). Highly significant attenuation of systolic blood pressure was observed in the fentanyl group with a 10% average lower value than the control over all measured points. As with SBP, high attenuation of the DBP pressor response to intubation in the fentanyl group was observed at all measured times – on average 10% greater attenuation than the control group. Conclusion: In conclusion, fentanyl attenuated the cardiovascular response to laryngoscopy & intubation, and was more effective in attenuating these responses. DBP was maintained in the fentanyl group. No patient manifested any ischemic ECG changes so fentanyl is safe in patients of ASA physical status I/II.
innovative publication
Introduction: Direct laryngoscopy and endotracheal intubation is an intrinsic component of general anaesthetic technique. It is a powerful stimulus which may evoke a plethora of sympathoadrenal stress responses. Various methods have been tried to attenuate the hemodynamic response. The objective of this study is to compare the effects of fentanyl, metoprolol, esmolol on the hemodynamic response during laryngoscopy and endotracheal intubation in normotensive individuals Methods: These 120 patients were randomly divided into 4 groups (F, M, E and S) to receive either the test drug or the control. GROUP F received fentanyl 1µg kg-1 , GROUP M received Metoprolol 25µg kg-1 , GROUP E received Esmolol 100µg kg-1 and GROUP S received saline to determine which drug best attenuated the pressor response to laryngoscopy and endotracheal intubation. Baseline heart rate and blood pressure were recorded during laryngoscopy, endotracheal intubation and up to 10 minutes prior to surgery. Results: Esmolol effectively reduced the increase in heart rate when given half a minute prior to laryngoscopy and endotracheal intubation. Fentanyl effectively reduced the increase in mean arterial pressure only after 3 minutes of laryngoscopy and endotracheal intubation (LETI). Metoprolol 25µg kg-1 produced a gradual reduction in heart rate and mean arterial pressure only after minutes of laryngoscopy making it ineffective for the same purpose. Conclusion: We conclude that esmolol and fentanyl can be safely used to attenuate the pressor response during laryngoscopy and intubation. Fentanyl may be used to attenuate pressor response in patient whom β-blockers are contraindicated like patients with second and third degree heart block, congestive heart failure, acute bronchospasm, and other hemodynamic instability.
Paripex Indian Journal Of Research, 2020
Background and Aims: The use of drugs to attenuate the haemodynamic response to laryngoscopy and endotracheal intubation is the standard of care during elective surgery. This study was conducted to compare the effect of two drug combinations using ketamine-propofol and fentanyl-propofol in attenuating haemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing general anaesthesia, duration of analgesia and side effects if any. Methods: After taking ethical committee clearance a randomized single blind prospective study involving 100 patients(18-60 years)of ASA-I and II undergoing GA for elective surgeries, were divided into 2 groups: Group K received Inj.Ketamine 0.5 mg/kg+inj.Propofol 2 mg/kg, Group F received Inj.Fentanyl 1.0 μg/kg+inj.Propofol 2 mg/kg. Haemodynamic parameters HR, SBP and DBP were recorded at baseline, after study drug, at 1min, 3min, 5 min, 10 min, 20 min after intubation and so on till completion of surgery. Pain score was assessed b...
Open Journal of Anesthesiology, 2019
Introduction: Laryngoscopic intubation is an insertion of endotracheal tube into the trachea for maintenance of airway during general anesthesia. Smooth intubation requires attenuation of pressor responses and maintenance of baseline hemodynamic stability. The primary outcome of this study is to compare intravenous fentanyl and lidocaine as an anesthetics adjuvant on attenuation of hemodynamic pressor responses to Laryngoscopic intubation in elective surgical adult patients. Methods: This prospective cohort study recruits 114 patients who underwent elective surgery under general anesthesia with laryngoscopy and endotracheal tube intubation. The study was conducted from January 1, 2018 to March 30, 2018. Systemic random sampling technique was used to select the study participants. Those patients that received intravenous fentanyl 2 micrograms per kilogram three minutes before intubation as an anesthetics adjuvant are considered as Fentanyl-group (group F). The Lidocaine-group (group L) was those patients who receive 2% intravenous lidocaine 1.5 milligrams per kilogram three minutes before intubation as anesthetics adjuvant. Hemodynamic parameters (heart rate and blood pressure) and other variables were documented starting from 3 minutes before intubation to 5 minutes after intubation. Results: The mean heart rate at first minute after intubation was significantly lower in fentanyl group (98.91 ± 15.6 beats per minute (bpm)) compared to lidocaine (107 ± 15.45 bpm), t (112) = 2.8, p = 0.006. Systolic blood pressure was also significantly lower in
Journal of Medical Science And clinical Research, 2019
The neurovegetative response to laryngoscopy and intubation has been a critical perioperative concern. Numerous pharmacological agents, such as opioids, local anaesthetics,-blockers and agonists has been tried to attenuate the haemodynamic challenge and augment analgesia. Dexmedetomidine is an adrenoceptor, while fentanyl is a μ receptor opioid agonist, both drugs have been clinically tried in various clinical role in anaesthesia practice. They have been claimed to produce sedation, anxiolysis, hypnosis, analgesia, and sympatholysis individually. Dexmedetomidine has been further found to have opioid sparing effect while fentanyl has been used in clinical practice as a sole anaesthetic that blunts the sympathetic response during intubation. These variable characteristics of two drugsare the point of consideration in the present study to compare their effects on haemodynamic response to laryngoscopy and analgesia.