Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.10.012
Brazilian Journal of Anesthesiology
Scientific Article

The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation

Comparação entre os efeitos de dexmedetomidina, fentanil e esmolol na prevenção da resposta hemodinâmica à intubação

Nermin Gogus; Belgin Akan; Nurten Serger; Mustafa Baydar

http://dx.doi.org/10.1016/j.bjane.2013.10.012 Braz J Anesthesiol, vol.64, n5, p.314-319, 2014
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Abstract

Background and objectives:Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response.Methods:Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I–II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study. Systolic, diastolic, mean arterial pressures, heart rates at the time of admittance at operation room were recorded as basal measurements. The patients were randomized into three groups: Group I (n = 30) received 1 μg/kg dexmedetomidine with infusion in 10 min, Group II (n = 30) received 2 μg/kg fentanyl, Group III received 2 mg/kg esmolol 2 min before induction. The patients were intubated in 3 min. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 3, 5, 10 min after intubation.Results:When basal levels were compared with the measurements of the groups, it was found that 5 and 10 min after intubation heart rate in Group I and systolic, diastolic, mean arterial pressures in Group III were lower than other measurements (p < 0.05).Conclusions:Dexmedetomidine was superior in the prevention of tachycardia. Esmolol prevented sytolic, diastolic, mean arterial pressure increases following intubation. We concluded that further studies are needed in order to find a strategy that prevents the increase in systemic blood pressure and heart rate both.

Keywords

Laryngoscopy, Intubation, Hemodynamic response, Dexmedetomidine, Fentanyl, Esmolol

Resumo

Justificativa e objetivos:Laringoscopia e intubação podem causar resposta hemodinâmica. Vários medicamentos podem ser usados para controlar essa resposta. Neste estudo, nosso objetivo foi comparar os efeitos de dexmedetomidina, fentanil e esmolol sobre a resposta hemodinâmica.Métodos:Foram incluídos no estudo prospectivo, randômico e duplo-cego 90 pacientes programados para cirurgias eletivas, com intubação endotraqueal, estado físico ASA I-II, entre 21 e 65 anos. Pressões arteriais médias, sistólicas, diastólicas e frequências cardíacas foram medidas ao darem entrada na sala de operações e registradas como valores basais. Os pacientes foram randomizados em três grupos: Grupo I (n = 30) recebeu 1 μg/kg de dexmedetomidina com infusão em 10 min; Grupo II (n = 30) recebeu 2 μg/kg de fentanil; Grupo III (n = 30) recebeu 2 mg/kg de esmolol 2 min antes da indução. Os pacientes foram intubados em 3 min. As pressões médias, sistólicas e diastólicas e as frequências cardíacas foram medidas antes da indução, antes da intubação e nos minutos 1, 3, 5 e 10 após a intubação.Resultados:Quando os níveis basais foram comparados entre os grupos, verificou-se que nos minutos 5 e 10 pós-intubação as frequências cardíacas no Grupo I e as pressões arteriais médias, sistólicas e diastólicas no Grupo III estavam mais baixas do que em outros tempos mensurados (p <0,05 ).Conclusões:Dexmedetomidina foi superior na prevenção de taquicardia. Esmolol preveniu o aumento das pressões arteriais médias, sistólicas e diastólicas após a intubação. Concluímos que estudos adicionais são necessários para descobrir uma estratégia que previna tanto o aumento da pressão arterial sistêmica quanto da frequência cardíaca.

Palavras-chave

Laringoscopia, Intubação, Resposta hemodinâmica, Dexmedetomidina, Fentanil, Esmolol

References

Hamaya Y, Dohi S. Differences in cardiovascular response to airway stimulation at different sites and blockade of the responses by lidocaine. Anesthesiology. 2000;93:95-103.

Bansal S, Pawar M. Haemodynamic responses to laryngoscopy and intubation in with pregnancy-induced hypertension; effect of intravenous esmolol with or without lidocaine. Int J Obstet Anesth. 2002;11:4-8.

Kurian SM, Evans R, Femandes NO. The effect of an infusion of esmolol on the incidence of myocardial ischaemia during tracheal extubation following coronary artery surgery. Anaesthesia. 2001;56:1163-8.

Yavascaoglu B, Kaya FN, Baykara M. A comparison of esmolol and dexmedetomidine for attenuation of intraocular pressure and haemodynamic responses to laryngoscopy and tracheal intubation. Eur J Anaesthesiol. 2008;25:517-9.

Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59:263-8.

Gupta S, Tank P. A comparative study of efficacy and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation. Saudi J Anaesth. 2011;5:2-8.

Hussain AM, Sultan ST. Efficacy of fentanyl and esmolol in the prevention of haemodynamic response to laryngoscopy and endotracheal intubation. J Coll Physicians Surg Pak. 2005;15:454-7.

Singh SP, Quadir A, Malhotra P. Comparison of esmolol and labetolol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation. Saudi J Anaesth. 2010;4:163-8.

Atlee JL, Dhamee MS, Olund TL. The use of esmolol, nicardipine, or their combination to blunt hemodynamic changes after laryngoscopy and tracheal intubation. Anesth Analg. 2000;90:280-5.

Figueredo EF, Fuentes MG. Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: a meta-analysis. Acta Anaesthesiol Scand. 2001;41:1011-22.

Adachi YU, Satomoto M, Higuchi H. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anesth Analg. 2002;95:233-7.

Ugur B, Ogurlu M, Gezer E. Effects of esmolol, lidocaine and fentanyl on haemodynamic responses to endotracheal intubation: a comparative study. Clin Drug Investig. 2007;27:269-77.

Talke P, Chen R, Thomas B. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000;90:834-9.

Hall JE, Uhrich TD, Barney JA. Sedative, amnestic and analgesic properties of small dose dexmedetomidine infusions. Anesth Analg. 2000;90:699-705.

Yildiz M, Tavlan A, Tuncer S. Effect of dexmedetomidine on haemodinamic responses to laryngoscopy and intubation: perioperative haemodynamics and anesthetic requirements. Drugs R D. 2006;7:43-52.

Ozkose Z, Demir FS, Pampal K. Hemodynamic and anesthetic advantages of dexmedetomidine, an α2-agonist, for surgery in prone position. Tohoku J Exp Med. 2006;210:153-60.

Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinical perceptions. Br J Anaesth. 2001;87:684-90.

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