A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

Abstract

A B S T R A C TBackground: Laryngoscopy and intubation are associated with a sympathetically mediated circulatory response due to irritation of respiratory tract which is associated with increase in pulse rate and blood pressure that may be dangerous. Aims and Objectives: The aim of the present study was to determine and compare the efficacy of dexmedetomidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and intubation and to detect any complication or side effect as a result of these drugs. Materials and Methods: Following approval by ethical committee, 60 ASA grade I and II patients of either sex undergoing general anaesthesia for elective surgery were included in this study. Patients were randomly divided into two groups of 30 patients each. Dexmedetomidine in a dose of 1µg/kg was given to Group A patients and Fentanyl 2 µg/kg was given to Group B patients. Both the drugs were diluted with normal saline solution to make 10ml and were administered slow intravenous 10 min before induction.The hemodynamic parameters were recorded, demographic data was analyzed using unpaired t-test and hemodynamic variables were analyzed by using unpaired and paired t-test. Side effects were analyzed using chi square test. Result: The two groups were comparable in their demographic profiles. Dexmedetomidine proved itself to be an excellent drug when given intravenously as a premedicant in dose of 1µg/kg to attenuate hemodynamic response to laryngoscopy and intubation. It blunted the hemodynamic response to laryngoscopy and intubation to a greater magnitude than fentanylin a dose of 2µg/kg intravenously as a premedicant. Conclusion: We conclude that fentanyl 2µg/kg i.v. given ten minutes prior to airway instrumentation shows an inconsistent response to laryngoscopy and intubation. Between the two drugs under study, the use of dexmedetomidine 1µg/kg i.v. is satisfactory and produces a more favorable hemodynamic profile while fentanyl 2µg/kg is found to be non-dependable and less effective for the attenuation of the pressor response to laryngoscopy and endotracheal intubation. However, further larger studies are required to strengthen these conclusions.

Comparative Study of Dexmedetomidine and Fentanyl for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation

“…Some of the pharmacological attempts made are topical anesthesia of the oropharynx, 6 drugs like lignocaine, 7 sedatives, vasoactive drugs like sodium nitroprusside, calcium channel blockers, beta blockers 8 and other drugs especially alpha 2 agonist like clonidine and dexmedetomidine. 9 Shribman 2 in 1987 described two components of pressor response: the first being the response to laryngoscopy and the second, the response to intubation. Laryngoscopy and intubation have been reported to be associated with a rise in plasma nor epinephrine levels by as much as 61%.…”

“…Laryngoscopy and intubation have been reported to be associated with a rise in plasma nor epinephrine levels by as much as 61%. 9 The marked sympathoadrenal response manifest in patients as hypertension and tachycardia. 10 Hence they are regarded as the most critical events during administration of general anesthesia.…”

“…There are studies in which the dose of dexmedetomidine ranges from 0.1 to 10 mcg/kg/hr, but the higher doses have been associated with bradycardia and hypotension. 18,19 Ozair et al 9 and Jain et al 4 in their studies of comparison of dexmedetomidine and fentanyl found the use of dexmedetomidine in the dose of 1 mcg/kg to be effective in controlling the pressor response to intubation without significant side effects. Taking these studies as references we gave dexmedetomidine in the dose of 1 mcg/kg in our study.…”

Fentanyl and Dexmedetomidine: A Comparative Study of Effects on Hemodynamic Response to Laryngoscopy, Intubation and Peri-Operative Analgesia

“…The modalities tried to attenuate this pressure response has targeted both the afferent (smooth and swift laryngoscopy, deeper plane of anaesthesia, increased MAC for volatile inhalational agents, topical lignocaine spray and intravenous opioids) as well as efferent limb (anti hypertensives, β-blockers, calcium channel blockers, vasodilators and adrenergic blockers). [14] This was a prospective, randomized, double blind, comparative study, undertaken to determine and compare the efficacy of dexmedetomidine and fentanyl in attenuating the pressor response to laryngoscopy and intubation and effects on analgesia. The two groups were matched demographically for age, height, weight, BMI and gender distribution and baseline hemodynamics, thus showing no confounding effect of these variables.…”

“…[22] There has been reports on inconsistent effects of Fentanyl on haemodynamics, when a bolus dose of 2μg/kg intravenous administered ten minutes prior to airway instrumentation, the increase in SBP, DBP, MAP and heart rate were above baseline levels after airway instrumentation. [14] In present study the core concerns of intraoperative inconsistent haemodynamic response to perioperative events like induction, intubation, intraoperative surgical instrumentation and extubation were addressed. The perioperative period was supplemented with a bolus preinduction doses of dexmedetomidine and fentanyl to respective group and an infusion of the same drug was continued till extubation.…”