Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.060
Brazilian Journal of Anesthesiology
Original Investigation

Comparison between dexmedetomidine and fentanyl bolus in attenuating the stress response to laryngoscopy and tracheal intubation: a randomized double-blind trial

Comparação entre dexmedetomidina e bolus de fentanil na atenuação da resposta ao estresse à laringoscopia e intubação traqueal: um ensaio duplo-cego randomizado

Aditya P Mahiswar; Prakash K Dubey; Alok Ranjan

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Abstract

Background and objectives: Laryngoscopy and tracheal intubation lead to a sympathoadrenal response. We compared the efficacy of dexmedetomidine with fentanyl bolus to attenuate this response.

Methods: One hundred patients admitted for routine surgical procedures under general anesthesia were enrolled in this double blind, randomized, controlled study. Patients were randomly assigned to two groups: Group F received injection of fentanyl 2 µg.kg-1 and Group D received injection of dexmedetomidine 0.5 µg.kg-1 diluted up to 5 mL by adding normal saline intravenously over 60 seconds. Five minutes thereafter, following induction with propofol and vecuronium, tracheal intubation was performed after 3 minutes of mask ventilation. Hemodynamic parameters were observed at an interval of 2 minutes before tracheal intubation and at an interval of 1 minute for 5 minutes after tracheal tube cuff inflation. Continuous variables are presented as mean with 95% confidence interval, and t-test was applied for comparing the difference of means between two groups after checking the normality condition. Chi-square test was applied to test the independence of attributes of categorical variables. Repeated measures two-way ANOVA was performed to compare the outcome variables between the two groups.

Results: The difference in heart rate and mean arterial pressure of patients in two groups after laryngoscopy and intubation was not statistically significant at any point of time. The hemodynamic changes did not require any intervention in the form of administration of rescue medication.

Conclusions: Dexmedetomidine 0.5 µg.kg-1 is as effective as fentanyl 2 µg.kg-1 in attenuating the hemodynamic response accompanying laryngoscopy and tracheal intubation.

Clinical trial number & registry URL: CTRI/2017/09/009857 [ctri.nic.in]

Keywords

Laryngoscopy, Hemodynamics, Fentanyl, Dexmedetomidine, Stress response

Resumo

Justificativa e objetivos: A laringoscopia e a intubação traqueal levam a uma resposta simpatoadrenal. Comparamos a eficácia da dexmedetomidina com bolus de fentanil para atenuar essa resposta.

Métodos: Cem pacientes admitidos para procedimentos cirúrgicos de rotina sob anestesia geral foram incluídos neste estudo duplo-cego, randomizado e controlado. Os pacientes foram aleatoriamente atribuídos a dois grupos: Grupo F recebeu injeção de fentanil 2 μg.kg-1 e Grupo D recebeu injeção de dexmedetomidina 0,5 μg.kg-1 diluída até 5 mL pela adição de solução salina normal por via intravenosa por mais de 60 segundos. Cinco minutos depois, após indução com propofol e vecurônio, a intubação traqueal foi realizada após 3 minutos de ventilação por máscara. Os parâmetros hemodinâmicos foram observados em um intervalo de 2 minutos antes da intubação traqueal e em um intervalo de 1 minuto por 5 minutos após a insuflação do balonete do tubo traqueal. Variáveis contínuas são apresentadas como média com intervalo de confiança de 95%, e o teste t foi aplicado para comparar a diferença de médias entre dois grupos após verificação da condição de normalidade. O teste do qui-quadrado foi aplicado para testar a independência dos atributos das variáveis categóricas. ANOVA bidirecional de medidas repetidas foi realizada para comparar as variáveis de resultado entre os dois grupos.

Resultados: A diferença na frequência cardíaca e pressão arterial média dos pacientes nos dois grupos após laringoscopia e intubação não foi estatisticamente significativa em nenhum momento. As alterações hemodinâmicas não exigiram nenhuma intervenção na forma de administração de medicação de resgate.

Conclusões: A dexmedetomidina 0,5 μg.kg-1 é tão eficaz quanto o fentanil 2 μg.kg-1 na atenuação da resposta hemodinâmica que acompanha a laringoscopia e intubação traqueal.

Palavras-chave

Laringoscopia, Hemodinâmica, Fentanil, Dexmedetomidina, Resposta ao estresse  

References

1 Sulaiman S, Karthekeyan RB, Vakamudi M, et al. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting. Ann Card Anaesth. 2012;15:39-43.

2 Kovac AL. Controlling the haemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1996;8:63-79.

3 Laha A, Ghosh S, Sarkar S. Attenuation of sympathoadrenal responses and anaesthetic requirement by dexmedetomidine. Anaesth Essays Res. 2013;7:65-70.

4 Vora KS, Baranda U, Shah VR, et al. The effects of dexmedetomidine on attenuation of hemodynamic changes and there effects as adjuvant in anesthesia during laparoscopic surgeries. Saudi J Anaesth. 2015;9:386-92.

5 Bilgi KV, Vasudevan A, Bidkar PU. Comparison of dexmedetomidine with fentanyl for maintenance of intraoperative hemodynamics in hypertensive patients undergoing major surgery: A randomized controlled trial. Anesth Essays Res. 2016;10:332-7.

6 Singla D, Parashar A, Pandey V, et al. Comparative evaluation of dexmedetomidine and labetalol for attenuating hemodynamic stress responses during laparoscopic cholecystectomy in borderline hypertensive patients. Rev Esp Anestesiol Reanim. 2019;66:181-8.

7 Bachofen M. Suppression of blood pressure increases during intubation: lidocaine or fentanyl? Anaesthesist. 1988;37:156-61.

8 Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand. 2005;49:1088-91.

9 Turan G, Ozgultekin A, Turan C, et al. Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery. Eur J Anaesthesiol. 2008;25:816-20.

10 Gunalan S, Venkatraman R, Sivarajan G, et al. Comparative evaluation of bolus administration of dexmedetomidine and fentanyl for stress attenuation during laryngoscopy and endotracheal intubation. J Clin Diagn Res. 2015;9:UC06-09.

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

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

13 Ko SH, Kim DC, Han YJ, et al. Small doses of fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation. Anesth Analg. 1998;86:658-61.

14 Jaakola ML, Ali-Melkkilä T, Kanto J, et al. Dexmedetomidine reduces intraocular pressure, intubation responses, and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth. 1992;68:570-5.

15 Lawrence CJ, De Lange S. Effects of a single preoperative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamics stability. Anaesthesia. 1997;52:736-44.

16 Bloor BC, Ward DS, Belleville JP, et al. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992;77:1134-42.

17 Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia. 1999;54:146-65.

18 Feld JM, Hoffman WE, Stechert MM, et al. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery. J Clin Anesth. 2006;18:24-8.

19 Ramsay MA, Saha D, Hebeler RF. Tracheal resection in the morbidly obese patient: The role of dexmedetomidine. J Clin Anesth. 2006;18:452-4.

20 Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59:263-70.

21 Ramsay MAE, Luterman DL. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology. 2004;101:787-90.

22 Bajwa SS, Kaur J, Singh A, et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian J Anaesth. 2012;56:123-8.
 


Submitted date:
12/11/2019

Accepted date:
02/27/2021

60b0edc4a95395502c52dbb4 rba Articles

Braz J Anesthesiol

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