Comparison between dexmedetomidine and fentanyl bolus in attenuating the stress response to laryngoscopy and tracheal intubation: a randomized double-blind trial
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.
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.
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.
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.
1 S. Sulaiman, R.B. Karthekeyan, M. Vakamudi, 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., 15 (2012), pp. 39-43
2 A.L. Kovac Controlling the haemodynamic response to laryngoscopy and endotracheal intubation J Clin Anesth., 8 (1996), pp. 63-79
3 A. Laha, S. Ghosh, S. Sarkar Attenuation of sympathoadrenal responses and anaesthetic requirement by dexmedetomidine Anaesth Essays Res., 7 (2013), pp. 65-70
4 K.S. Vora, U. Baranda, V.R. Shah, et al. The effects of dexmedetomidine on attenuation of hemodynamic changes and there effects as adjuvant in anesthesia during laparoscopic surgeries Saudi J Anaesth., 9 (2015), pp. 386-392
5 K.V. Bilgi, A. Vasudevan, P.U. Bidkar Comparison of dexmedetomidine with fentanyl for maintenance of intraoperative hemodynamics in hypertensive patients undergoing major surgery: A randomized controlled trial Anesth Essays Res., 10 (2016), pp. 332-337
6 D. Singla, A. Parashar, V. Pandey, et al. Comparative evaluation of dexmedetomidine and labetalol for attenuating hemodynamic stress responses during laparoscopic cholecystectomy in borderline hypertensive patients Rev Esp Anestesiol Reanim., 66 (2019), pp. 181-188
7 M. Bachofen Suppression of blood pressure increases during intubation: lidocaine or fentanyl? Anaesthesist., 37 (1988), pp. 156-161
8 G. Guler, A. Akin, Z. Tosun, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation Acta Anaesthesiol Scand., 49 (2005), pp. 1088-1091
9 G. Turan, A. Ozgultekin, C. Turan, et al. Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery Eur J Anaesthesiol., 25 (2008), pp. 816-820
10 S. Gunalan, R. Venkatraman, G. Sivarajan, et al. Comparative evaluation of bolus administration of dexmedetomidine and fentanyl for stress attenuation during laryngoscopy and endotracheal intubation J Clin Diagn Res., 9 (2015), pp. UC06-09
11 Y.U. Adachi, M. Satomoto, H. Higuchi, et al. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy Anesth Analg., 95 (2002), pp. 233-237
12 S. Gupta, P. Tank A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation Saudi J Anaesth., 5 (2011), pp. 2-8
13 S.H. Ko, D.C. Kim, Y.J. Han, et al. Small doses of fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation Anesth Analg., 86 (1998), pp. 658-661
14 M.L. Jaakola, T. Ali-Melkkilä, J. Kanto, et al. Dexmedetomidine reduces intraocular pressure, intubation responses, and anaesthetic requirements in patients undergoing ophthalmic surgery Br J Anaesth., 68 (1992), pp. 570-575
15 C.J. Lawrence, S. De Lange Effects of a single preoperative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamics stability Anaesthesia., 52 (1997), pp. 736-744
16 B.C. Bloor, D.S. Ward, J.P. Belleville, et al. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes Anesthesiology., 77 (1992), pp. 1134-1142
17 Z.P. Khan, C.N. Ferguson, R.M. Jones Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role Anaesthesia., 54 (1999), pp. 146-165
18 J.M. Feld, W.E. Hoffman, M.M. Stechert, et al. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery J Clin Anesth., 18 (2006), pp. 24-28
19 M.A. Ramsay, D. Saha, R.F. Hebeler Tracheal resection in the morbidly obese patient: The role of dexmedetomidine J Clin Anesth., 18 (2006), pp. 452-454
20 N. Bhana, K.L. Goa, K.J. McClellan Dexmedetomidine Drugs., 59 (2000), pp. 263-270
21 M.A.E. Ramsay, D.L. Luterman Dexmedetomidine as a total intravenous anesthetic agent Anesthesiology., 101 (2004), pp. 787-790
22 S.S. Bajwa, J. Kaur, A. Singh, et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine Indian J Anaesth., 56 (2012), pp. 123-128