ATTENUATION OF HAEMODYNAMIC RESPONSE DURING LARYNGOSCOPIC INTUBATION WITH FENTANYL

Abstract

Introduction: Identified as a depth-of-anesthesia-dependent influencing factor, endotracheal intubation has been suggested to be one of the most invasive stimuli in anesthesia, particularly during induction³ and after tracheal intubation. The objective of the study was to find a safe and effective means of attenuating the cardiovascular response to laryngoscopy and tracheal intubation.

Methodology: S.A.L Hospital and Medical institute and KESAR SAL Medical College and Research Institute, Ahmedabad during 2008-2010 in 100 patients, divided in two groups having 50 patients in each group. One group received intravenous fentanyl while other group termed as control group received intravenous normal saline. The following hemodynamic variables were considered for study: changes in heart rate and comparison of the controlled group with the group who received fentanyl; & changes in systolic arterial pressure and diastolic arterial pressure in the fentanyl treated group in comparison to the control group.

Results: At induction both the groups were observed to have a 5% decrease in heart rate in comparison to basal levels. At intubation, however, the fentanyl group had a highly significant mean heart rate at 12% below the control group (P≤0.0001). Highly significant attenuation of systolic blood pressure was observed in the fentanyl group with a 10% average lower value than the control over all measured points. As with SBP, high attenuation of the DBP pressor response to intubation in the fentanyl group was observed at all measured times – on average 10% greater attenuation than the control group.

Conclusion: In conclusion, fentanyl attenuated the cardiovascular response to laryngoscopy & intubation, and was more effective in attenuating these responses. DBP was maintained in the fentanyl group. No patient manifested any ischemic ECG changes so fentanyl is safe in patients of ASA physical status I/II.