Reflex activity caused by laryngoscopy and intubation is obtunded differently by meptazinol, nalbuphine and fentanyl

Freye, Enno; Levy, Joseph V.

doi:10.1097/00003643-200701000-00009

Cited by 9 publications

(10 citation statements)

References 30 publications

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“…Laryngoscopy and intubation cause great stress to patients, either psychoemotional due to fear of the procedure, or physical due to nociceptive stimulation of pharyngeal, laryngeal mucosa and tracheal receptors during the intubation (Freye and Levy, 2007). Patient reaction to the stress caused by tracheal intubation may produce adverse cardiovascular complications in patients with cardiovascular disease in the case history and in patients without any comorbidities (Xue et al, 2006;Paisansathan et al, 2007), but especially in patients in acute situations.…”

Section: Introductionmentioning

confidence: 99%

Comparison Of Stress Response Performing Endotracheal Intubation By Direct Laryngoscopy, Fibreoptic Intubation And Intubation By The Glidescope Laryngoscope

Jakušenko¹,

Kopeika²,

Mihelsons³

et al. 2008

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Comparison Of Stress Response Performing Endotracheal Intubation By Direct Laryngoscopy, Fibreoptic Intubation And Intubation By The Glidescope Laryngoscope Stress response is regulated by two primary neuroendocrine systems—the hypothalamuspituitary- adrenocortical (HPA) and sympathetic adrenomedullary (SAM) systems. Salivary alphaamylase (AA) levels can be used as an index of the SAM activity, and serum cortisol as an index of HPA activity. The aim of the study was to compare patient stress response to different intubation techniques. Sixty adult patients, ASA I-III, scheduled for elective abdominal surgery were included in this study, with median age of 54±18 years. Patients were prospectively randomly divided into three groups-intubation with a GlideScope (GS), Macintosh laringoscope (ML) and PENTAX fibreoptic bronchoscope (FB). After preoxygenation for 3 min anaesthesia was induced with fentanyl 2 mkg/kg, mivacuronium 0.2 mg/kg and propofol 2 mg/kg, injected intravenously over 20 seconds. Intubation was started 2 min after mivacuronium injection. Anaesthesia was maintained with sevoflurane 1-2 vol% and fentanyl 1 mkg/kg as needed. Intubation time (IT) was measured, blood and saliva samples were collected before and shortly after intubation. Haemodynamic response was recorded. Intubation time was statistically significantly longer in the FB group (120±65 s) versus the ML group (29±5 s) and GS group (26±9 s), P < 0.05. In the three patients groups the initial AA level was similar (54±20 KU/ml, P > 0.05). In GS patients the alpha amylase level after intubation significantly decreased (42±15 KU/ml, P < 0.05), but in ML and FB patients—significantly increased (68±24 KU/ml and 73±32 KU/ml, respectively, P < 0.05). After intubation, blood cortisol did not differ between the ML (377±181 U/ml) and GS (484±61 U/ml) patient groups, but was significantly higher (P < 0.05) in the FB group (530±79 U/ml). Both heart rate and blood pressure increased during intubation, the difference between groups was not significant. All intubations were successful, but in the FB patient group IT was significantly longer than in the ML and GS patient group. IT in the GS and FB patient groups did not statistically significantly differ. In our opinion, shorter and more confident intubations with a GlideScope produce less nociceptive stimulus and less stress to the patient. Intubations using GlideScope videolaryngoscope causes lesser stress response in comparison to intubation with a Macintosh laryngoscope or fibreoptic bronchoscope.

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Section: Introductionmentioning

confidence: 99%

Comparison Of Stress Response Performing Endotracheal Intubation By Direct Laryngoscopy, Fibreoptic Intubation And Intubation By The Glidescope Laryngoscope

Jakušenko¹,

Kopeika²,

Mihelsons³

et al. 2008

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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“…Nalbuphine, on the other hand, has the advantage of a respiratory depressant ceiling-effect compared to fentanyl. 7 Nalbuphine being a non-narcotic drug recently made available, over the counter, can serve an alternate to fentanyl in scenarios where fentanyl is not available or can't be used. Nalbuphine, unlike other agonist-antagonist opioids does not increase systemic blood pressure, pulmonary artery blood pressure, heart rate or atrial filling pressure.…”

Section: Discussionmentioning

confidence: 99%

Comparison of fentanyl and nalbuphine in obtunding stressor response to laryngoscopy and endotracheal intubation

Mitragotri¹,

Sheikh²,

Sachinananda³

et al. 2021

IJCA

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: Fentanyl has evinced its property of being a potent opioid and benumbing stress response to laryngoscopy and intubation (L&I). However respiratory depression and chest wall rigidity limits its utility at high doses. Nalbuphine, reported to have a ceiling effect for respiratory depression, can serve as an alternative. We studied and compared the efficacy of fentanyl and nalbuphine in preventing the rise in heart rate and blood pressure after L&I. A randomized double blind study was conducted in 60 subjects divided in two groups (Group F n=30 and Group N n=30) was done. Group F received 2µg kg fentanyl intravenously while group N received nalbuphine 0.2mg kg intravenously. Hemodynamic variables including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured at baseline and at intervals of five minutes of administering test drug, each minute up to five minutes after intubation, 10 minutes and 30 minutes after intubation. Complications, if any, were recorded after surgery. Change in HR, SBP, DBP and MAP between the two groups was compared using independent t-test. : The two drugs were equally effective in preventing HR rise at all-time points except after 30 minutes where fentanyl performed better. The change in SBP, DBP and MAP from baseline in both the groups was comparable.: Nalbuphine can serve as an alternative to fentanyl in obtunding stress response when given five minutes before intubation.

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“…Freye et al [14] (2001) conducted study to compare cardiovascular response to laryngoscopy and tracheal intubation with fentanyl and nalbuphine and found that significant increase in systolic blood pressure in nalbuphine group as compared to fentanyl.…”

Section: Mean Arterialmentioning

confidence: 99%

To Evaluate the Comparison of Intubating Conditions Using Fentanyl Plus Propofol Versus Nalbuphine Plus Propofol During Fiberoptic Intubation

Kaur¹,

Chawla²,

Kumar³

et al. 2018

jemds

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BACKGROUND Awake nasal or oral flexible fiberoptic intubation (AFOI) is the airway management technique of choice in known or anticipated difficult airway, severe cervical stenosis, Chiari malformation, unstable cervical fracture, limited mouth opening as in temporomandibular disease, mandibular-maxillary fixation, severe facial burn and vertebral artery insufficiency. [1] Fiberoptic intubation is the best, easiest and most successful method for awake intubation. MATERIALS AND METHODS A prospective, comparative and randomized study was conducted on 100 patients undergoing elective surgery under general anaesthesia. Patients were randomly divided into two groups of 50 each. Group I: Patient received bolus of I.V. fentanyl 1 ug/kg+ propofol 1 mg/kg so as to achieve an adequate level of sedation i.e. RSS=3. Group II: Patient received bolus of I.V. nalbuphine 0.2 mg/kg + propofol 1 mg/kg to achieve adequate level of sedation. Haemodynamic parameters (heart rate, systolic and diastolic blood pressure, mean arterial pressure), SpO2, EtCO2, total comfort scale and patient's tolerance were assessed during preoxygenation, fiberscope insertion and endotracheal intubation. RESULTS Significant difference (p<0.05) between two groups in terms of HR, SBP, DBP, MAP, total comfort score and patient tolerance was seen during fiberscope insertion and endotracheal intubation. CONCLUSION Fentanyl plus propofol regimes are suitable for fiberoptic intubation. Fentanyl plus propofol appeared to offer better tolerance, preservation of an airway and spontaneous ventilation, while maintaining haemodynamic stability.

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Reflex activity caused by laryngoscopy and intubation is obtunded differently by meptazinol, nalbuphine and fentanyl

Cited by 9 publications

References 30 publications

Comparison Of Stress Response Performing Endotracheal Intubation By Direct Laryngoscopy, Fibreoptic Intubation And Intubation By The Glidescope Laryngoscope

Comparison Of Stress Response Performing Endotracheal Intubation By Direct Laryngoscopy, Fibreoptic Intubation And Intubation By The Glidescope Laryngoscope

Comparison of fentanyl and nalbuphine in obtunding stressor response to laryngoscopy and endotracheal intubation

To Evaluate the Comparison of Intubating Conditions Using Fentanyl Plus Propofol Versus Nalbuphine Plus Propofol During Fiberoptic Intubation

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