Comparative Study Of The Effect Of Esmolol, Fentanyl And Their Combination For Attenuating Haemodynamic Responses Of Laryngoscopy And Intubation

Comparative Study Of The Effect of Esmolol, Fentanyl And Their Combination

Authors

  • Dr.Manisha Bhagat
  • Dr.Mukesh Kumar
  • Dr.Rajesh Khanna
  • Dr.Usha Suwalka

DOI:

https://doi.org/10.70284/njirm.v5i3.724

Keywords:

Haemodynamic responses, laryngoscopy, intubation, esmolol, fentanly

Abstract

Background&Objectives: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy, intubation and extubation. The reflex increases in sympathoadrenergic activity caused by these manipulations leads to an increase in catecholamine release, arterial blood pressure and heart rate. The aim of present study was to evaluate the efficacy of Fentanyl (2 mcg/kg), Esmolol (1mg/kg) and their combination in half the dose(fentanyl 1 mcg/kg +esmolol 0.5mg/kg) in attenuating the pressure response during laryngoscopy and tracheal intubation. Methods: This is a prospective double blind study comprising ninety patients between 21-60 yrs and ASA grade I and II scheduled for elective surgery under general anesthesia. Patients were randomly divided into group E (injection Esmolol 1mg/kg iv), group F (inj.Fentanyl 2mcg/kg iv) and group C (inj.Esmolol 0.5mg/kg and inj.Fentanyl 1mcg/kg). The study drug was given 2 minutes before induction of anaesthesia. All the vital parameters of patients were observed during intra operative and postoperative period .Values of heart rate and mean blood pressure were recorded at pre-induction, after giving study drug, after induction, immediately after intubation and at 1 min, 3 min, 5 min, 7 min and 10 min. after intubation. Results: Inter group comparison of groups E, F & C showed greater attenuation of heart rate in group F as compared to group C and group E. Inter group comparison of groups E, F & C in attenuating increase in MAP showed greater attenuation of MAP in group F as compared to group E ( p=0.880) and group C (p=0.0005). Conclusion: Among the fentanyl (2 mcg/kg), esmolol (1 mg/kg) and their combination drug in half doses, injection fentanyl is best in attenuating haemodynamic responses to laryngoscopy and tracheal intubation. [ Bhagat M NJIRM 2014; 5(3) :1-6]

References

1. King BD, Harris LC, Greifenstein FE, Elder JD, Dripps RD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology 1951;12:556-66.
2. Stoelting RK. Circulatory changes during direct laryngosocpy and tracheal intubation - influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977;47(4):381-4.
3. Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: Intravenous or laryngotracheal? Anesthesiology 1981; 55: 578-81.
4. Kautto UM, Heinonen J. Attenuation of circulatory response to laryngoscopy and tracheal intubation: A comparison of two methods of topical anaesthesia. Acta AnaesthesiolScand1982;26:599-602.
5. Vucevic M, Purdy GM, Ellis FR. Esmolol hydrochloride for management of the cardiovascular stress responses to laryngoscopy and tracheal intubation. Br J Anaesth1992;68:529-30.
6. Yaku H, Mikawa K, Maekawa N, Obara H. Effects of verapamil on the cardiovascular responses to tracheal intubation. BrJAnaesth1992;68:85-9.
7. Wig J, Sharma M, Baichoo N, Agarwal A. Nicardipine and verapamil attenuate the pressor response to laryngoscopy and intubation. Can J Anaesth 1994; 41: 1185-8.
8. Casati A, Fanelli G, Albertin A, Deni F, Daneili G, Grifoni F, Torri G. Small doses of remifentanil or sufentanil for blunting cardiovascular changes induced by tracheal intubation: A double blind comparison. Eur J Anaesthesiol 2001; 18: 108-12.
9. 9.Basu SM, Pramanik S. Duration and degree of circulatory changes following laryngoscopy and intubation and study of a method of attenuation
of these changes. Indian J Anaesthesia 1988 Feb;36(1):29-31.
10. 10.Steolting RK. Circulatory changes during laryngoscopy and tracheal intubation: Influence of duration of laryngoscopy with or without prior lidocaine. Anaesthesiology 1977;47:381-3.
11. 11.Fassoulaki A, Kaniaris P. Intranasal nitroglycerine attenuates the pressor response to laryngoscopy and intubation of trachea. Br J Anaesth 1979;58:116-9.
12. 12.Elbert JP, Pearsonj JD, Gelman S, et al. Circulatory responses to laryngoscopy and endotracheal intubation: The comparative effects of placebo, fentanyl and esmolol. Can J Anaesth 1989;36:301.
13. 13.Mikawa K, Ikegaki K, et al. the effect of diltiazem on cardiovascular response to intubation. Anaesthesia 1990;45:289-93.
14. 14.AbouMadi MN, Keszler H, Yacoub JM. Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large I.V. doses of lidocaine.Can AnaesthSoc J 1977 Jan;24(1):12-90.
15. 15.Prys Roberts C, Green LT, Foex P. Studies of anaesthesia in relation to hypertension II Hemodynamic consequence of induction and endotracheal intubation. Br J Anaesth 1971;43:531-47.
16. 16.Scheinin B, Scheinin M, Vourinen J, Lindgren L. Alfentanil obtunds the cardiovascular and sympathoadrenal responses to suxamethonium facilitated laryngoscopy and intubation. Br J Anaesth 1989;62:385-92.
17. 17.Gaubatz CL, Wehner RJ. Evaluation of esmolol and fentanyl in controlling increase in heart rate and blood pressure during endotracheal intubation.AANA J 1991 Feb;59(1):91-6.
18. 18.Chung KS, Sinatra RS, Halevy JD, Paige D, Silverman DG. A comparison of fentanyl, esmolol and their combination for blunting the haemodynamic responses during rapid-sequence induction.Can J Anaesth 1992;39(8):774-9.
19. 19.Miller DR, O’Brien H. Effect of alfentanil on the hemodynamic and catecholamine response to tracheal intubation. Anesthesia and Analgesia 1998;76:165-169.
20. 20.Woo YC. The effects of a combination of fentanyl and esmolol on hemodynamic responses after endotracheal intubation inhypertensive patients.Korean J Anaesthsiol 1999 Dec;37(6):995-1000.
21. John P. Ebert, James D. Pearson, Simon Gelman, ConstanceHarris, Edwin L. Bradley. Circulatory response to laryngoscopy: the comparative effects of placebo, fentanyl and esmolol. Can J Anaesth 1989;36(3):301-6.
22. 22.Yuan L, Chia YY, Jan KT, Chen CS, Wang CH, HaungLH,Kang L. The effect of single bolus dose of esmolol for controlling the tachycardia and hypertension during laryngoscopy and tracheal intubation.ActaAnaesthesiol Sin 1994 Sep;32(3):147-52.
23. 23.Sharma S, Ghani AA, Win N, Ahmed M. Comparison of two bolus doses of esmolol for attenuation of haemodynamic response to tracheal intubation. Med J Malaysia 1995 Dec;50(4):372-6.

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Published

2014-06-30

How to Cite

Bhagat, D., Kumar, D., Khanna, D., & Suwalka, D. (2014). Comparative Study Of The Effect Of Esmolol, Fentanyl And Their Combination For Attenuating Haemodynamic Responses Of Laryngoscopy And Intubation: Comparative Study Of The Effect of Esmolol, Fentanyl And Their Combination. National Journal of Integrated Research in Medicine, 5(3), 1–6. https://doi.org/10.70284/njirm.v5i3.724

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