“Comparative Efficacy of Different Doses of Fentanyl on Cardiovascular Responses to Laryngoscopy and Tracheal Intubation”

Abstract

IntrOductIOnLaryngoscopy and tracheal intubation can cause tachycardia, hypertension, dysarrhythmias, perioperative myocardial ischaemia, acute heart failure, and cerebrovascular accidents in susceptible individuals [1] .These responses are due to intense sympathetic discharge caused by stimulation of upper respiratory tract, evidenced by rise in catecholamine's. Various drugs and techniques like, topical and IV Lignocaine, deepening level of anaesthesia, adrenergic blockers, vasodilators like, alpha blockers, and opioids have been used [1]. Fentanyl, a synthetic opioid which attenuates the cardiovascular response by its action on opioid receptors, effects on cardiovascular system, preventing the increase in plasma concentrations of catecholamines and decreasing the central sympathetic vasoregulatory outflow. We conducted a randomized double blind controlled study to determine the effective dose of fentanyl to attenuate the cardiovascular effects of laryngoscopy and tracheal intubation. MAterIAls And MethOdsWe conducted a randomized double blind controlled study on 50 ASA physical status I and II patients, aged between 20-60 years, scheduled for elective surgery requiring general anaesthesia. Institutional ethical committee approval and informed consent was obtained. Patients with history of hypertension, angina, coronary artery disease, recent myocardial infarction, congestive cardiac failure, heart blocks, cardiac pace maker, chronic obstructive pulmonary disease, pregnant and nursing women, anticipated difficult airway and patients on treatment with anti-hypertensive and anti arrhythmic drugs were excluded from study. All the patients were randomly allocated in a double blind fashion and using a sealed envelope technique to one of the two groups, fentanyl 3µg/ kg (group A), fentanyl 5µg/kg (group B) each containing 25 patients. All the patients were premedicated with Inj.glycopyrrolate 0.2 mg intramuscularly and midazolam 0.05mg/kg IM, 30 min prior to

Effect of different doses of intravenous oxycodone and fentanyl on intubation-related hemodynamic responses

“…The onset and action duration of fentanyl is 2 to 3 minutes and 3 hours 39 minutes, respectively. [7,20] While intravenous oxycodone has an onset similar to that of fentanyl, it has a longer action duration (4 hours 52 minutes) than that of fentanyl. [7,20] The peak effect of fentanyl and oxycodone is achieved within 5 minutes and 15 to 30 minutes after intravenous injection, respectively.…”

Optimal dose of intravenous oxycodone for attenuating hemodynamic changes after endotracheal intubation in healthy patients

“…Furthermore, 5 μg/kg fentanyl was suggested to completely abolish the hemodynamic responses to tracheal intubation in another study. [9] However, there have not been enough trials to determine the optimal dose of IV oxycodone to minimize the changes in HR and BP after intubation.…”

“…However, 4 μg/kg fentanyl was needed to achieve stabilization of HR and MAP in patients with hypertension. [3] Hosalli et al [9] found no statistically significant difference in the mean HR between a fentanyl 3 μg/kg group and a 5 μg/kg group in healthy patients without hypertension. There was another study that evaluated hemodynamic response to intubation using alfentanil, esmolol, and their combination.…”

“…However, the duration of action was longer than that of fentanyl ( t 1/2 : 4 hours 52 minutes vs. 3 hours 39 minutes). [9] Therefore, after a short procedure, such as removal of metal after an internal fixation of an extremity fracture or tendon release, the effect of oxycodone may persist until the emergence period, stabilizing the hemodynamics in the meantime.…”

To compare the effect of two different doses of dexmedetomidine on the attenuation of airway and pressor response during tracheostomy tube change in traumatic brain injury patients

“…[ 9 ] DEX has a relatively high ratio of α 2 /α 1 -activity, the α 2 :α 1 binding selectivity ratio 1620:1; therefore, DEX is a highly specific and selective α 2 -adrenergic receptor agonist. [ 10 11 ] Previous studies that had used intravenous (IV) boluses of DEX showed decrease in BP and cardiac output after small boluses (0.25–1 μg/kg), which were associated with decrease in serum norepinephrine concentration. [ 12 13 ] Review of previous literature showed that DEX has been extensively used for attenuation of pressor response during laryngoscopy and tracheal intubation, but literature on attenuation of pressor response during TT change is not available.…”