A Comparison Of Intravenous Dexmedetomidine V/S Inj. Fentanyl For Attenuation Of Hemodynamic Responses During Laryngoscopy And Intubation After Propofol Induction

A Comparison Of Intravenous Dexmedetomidine Versus Inj. Fentanyl

Authors

  • Dr. Ramesh Kumar Kharwar
  • Dr. Mukesh Kumar
  • Dr. Prawin Kumar Tiwary
  • Dr. Usha Suwalka
  • Dr.Shanti Prakash

Keywords:

Laryngoscopy and intubation, hemodynamic responses, dexmedetomidine, fentanyl, Propofol

Abstract

Background And Objective: Alpha-2 agonists are being increasingly used as adjuncts in general anaesthesia, Fentanyl an opioid analgesic, is popular as an intraoperative agent due to the cardiovascular stability provided by it, even in critically ill patients.Present study was carried out to evaluate the effect of dexmedetomidine and fentanyl for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation. Methods: Sixty patients scheduled for elective general surgery under general anaesthesia were randomized into two groups: A and B (n=30 in each group). Study group A patients were given inj. dexmedetomidine 1μg kg-1 diluted to 20ml normal saline infused in 10 minutes with infusion pump and group B were given inj. fentanyl 2μg kg-1 diluted to 20ml normal saline infused in 10 minutes with infusion pump, inj. Propofol (2mg/kg) i.v were used as induction agent. Anaesthesia was maintained with 40:60 oxygen: nitrous oxide, isoflurane (0.6%) and muscle relaxant vecuronium bromide in incremental doses throughout the surgery. Haemodynamic parameters were recorded at regular intervals during induction, intubation, surgery and extubation. Results: After induction there was significant decrease in pulse rate with dexmedetomidine and significant decrease in Mean blood pressure was seen with fentanyl group. After laryngoscopy and intubation, increase in pulse rate and mean arterial blood pressure was more in fentanyl group than in dexmedetomidine group. Interpretation and Conclusion: we conclude that dexmedetomidine 1μg/kg is more effective in attenuating hemodynamic pressure responses to laryngoscopy and intubation than 2μg/kg fentanyl when given as premedication.[ DKharwar R NJIRM 2014; 5(3) :71-75

References

1. Burstein C.L.; La Pinto F.J. et al. Electrocardiographic studies during endotracheal Intubation. Anaesthesiology, 1950;11:224.
2. Wycoff et al, endotracheal intubation effects on BP & heart rate. Anaesthesiology,1960;21:1553-8.
3. Forbes & Dally et al. Acute hypertension during induction of anaesthesia & endotracheal intubation in normotensive person. BJA 1970;42:618.
4. Shribman AJ, Smith G, Achola KJ. Cardiovascular & catecholamine responses to laryngoscopy with & without tracheal intubation. BJA 1987; 59: 295-9.5. Reid LC, Brace DE. Irritation of the respiratory tract and its reflex effect on heart. Surg Gynae Obstet 1940; 70: 157-62.
6. Derbyshire et al. Plasma catecholamine responses to tracheal intubation. BJA, 1983; 55: 855-60.
7. Karl et al. Insertion of LMA in place of endotracheal intubation to attenuate the cardiovascular response. IJA, 1999;43:30-35.
8. Kumar et al. Blocking Glossopharyngeal and superior laryngeal nerves to attenuate the cardiovascular response to laryngoscopy and endotracheal intubation. IJA, 1993;41:20-25.
9. Takita K, Morimoto Y, Kemmotsu O. Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation. Can J Anaesth 2001; 48:732-36.
10. Kulka PJ, Tryba M, Zenz M. Dose response effects of intravenous clonidine on stress response during induction of anaesthesia in coronary artery bypass graft patients. Anaesthesia. Analg 1995; 80: 263-68.
11. Bruder N, Ortega D, Granthil C. Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation. Ann Fr Anesth Reanim1992;11:57–71.
12. Palmer CM,Van Maren G,Nogami WM,Alves D.Bupivacine augments intrathecal fentanyl for labour analgesia.Anesthesiology1999;91:84-9.
13. Savola JM, Ruskoaho H, Puurunen J, Salonen JS, Karki NT. Evidence for medetomidine as a selective and potent agonist at a2-adrenoreceptors. J Autonomic Pharmacol 1986;5:275-84.
14. Virtanen R, Savola JM, Saano V, Nyman L. Characterisation of selectivity, specificity and potency of medetomidine as an a2-receptor agonist. Eur J Pharmacol 1988;150:9-11.
15. Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans II. Hemodynamic changes.Anesthesiology 1992;77:1134-42.
16. Hall JE, Uhrich TD, Barney JA, Shahbaz RA, Ebert TJ. Sedative, amnestic and analgesic properties of small dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705.
17. Chung KS, Sinatra RS, Halevy JD, Paige D, Silverman DG. Comparison of fentanyl, esmolol and their combination for blunting the
hemodynamic responses during rapid sequence induction. Can J Anaesthesia, 1992; 39: 774-79.
18. Singh H, Vichitvejpaisal P, Gaines GY, White PF. Comparative effect of lidocaine, esmolol and NTG in modifying the hemodynamic response to laryngoscopy and intubation. Clin Anaesth 1995; 7: 1155-8.
19. A.D. Malde, V. Sarode: Attenuation Of The Hemodynamic Response To Endotracheal Intubation: Fentanyl Versus Lignocaine. The Internet Journal of Anesthesiology, 2007;12.
20. Feld JM, Hoffman WE, Stechert MM, Hoffman IW, Ananda RC. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery. Journal of Clinical Anaesthesiology 2006;18: 24-8.
21. Yildiz, Munise, Tavlan, Aybars, Sema, Reisli, Ruhiye, Yosunkaya, Alper, Otelcioglu, Seref. Effect of Dexmedetomidine on hemodynamic responses to laryngoscopy and intubation: Perioperative hemodynamic and anaesthetic requirements. Drugs in R and D 2006;7: 43-52.
22. Recep Aksu, Aynur Akin, Cihangir Biçer, Aliye Esmaoğlu, Zeynep Tosun, Adem Boyaci. Comparison of the effects of Dexmedetomidine versus Fentanyl on airway reflexes and hemodynamic responses to tracheal extubation during rhinoplasty: A Double-Blind, Randomized, Controlled Study. Current Therapeutic Research 2009;70: 209–220.

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Published

2018-01-03

How to Cite

Kharwar, D. R. K., Kumar, D. M., Tiwary, D. P. K., Suwalka, D. U., & Prakash, D. (2018). A Comparison Of Intravenous Dexmedetomidine V/S Inj. Fentanyl For Attenuation Of Hemodynamic Responses During Laryngoscopy And Intubation After Propofol Induction: A Comparison Of Intravenous Dexmedetomidine Versus Inj. Fentanyl. National Journal of Integrated Research in Medicine, 5(3), 59–63. Retrieved from http://nicpd.ac.in/ojs-/index.php/njirm/article/view/735

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