Abstract
Introduction: Laryngoscopic intubation is an insertion of endotracheal tube into the trachea for maintenance of airway during general anesthesia. Smooth intubation requires attenuation of pressor responses and maintenance of baseline hemodynamic stability. The primary outcome of this study is to compare intravenous fentanyl and lidocaine as an anesthetics adjuvant on attenuation of hemodynamic pressor responses to Laryngoscopic intubation in elective surgical adult patients. Methods: This prospective cohort study recruits 114 patients who underwent elective surgery under general anesthesia with laryngoscopy and endotracheal tube intubation. The study was conducted from January 1, 2018 to March 30, 2018. Systemic random sampling technique was used to select the study participants. Those patients that received intravenous fentanyl 2 micrograms per kilogram three minutes before intubation as an anesthetics adjuvant are considered as Fentanyl-group (group F). The Lidocaine-group (group L) was those patients who receive 2% intravenous lidocaine 1.5 milligrams per kilogram three minutes before intubation as anesthetics adjuvant. Hemodynamic parameters (heart rate and blood pressure) and other variables were documented starting from 3 minutes before intubation to 5 minutes after intubation. Results: The mean heart rate at first minute after intubation was significantly lower in fentanyl group (98.91 ± 15.6 beats per minute (bpm)) compared to lidocaine (107 ± 15.45 bpm), t (112) = 2.8, p = 0.006. Systolic blood pressure was also significantly lower in fentanyl group (141.9 ± 18.9 millimeters of mercury (mmHg)) compared to lidocaine (150 ± 18.098 mmHg), t (112) = 2.45, p = 0.016 at first minute after intubation. At third minute after intubation, heart rate was significantly lower in fentanyl group compared to lidocaine, t (112), p = 0.037. No difference was in heart rate and blood pressure among the group at 5th minute after intubation (p > 0.05). Conclusion and Recommendations: Fentanyl was better on attenuation of hemodynamic pressor responses to laryngoscopic intubation when compared to lidocaine. Therefore, using fentanyl pre-operatively to attenuate pressor responses especially during intubation is important.
Highlights
Laryngoscopic intubation is an insertion of endotracheal tube into the trachea for maintenance of airway during general anesthesia
At third minute after intubation, heart rate was significantly lower in fentanyl group compared to lidocaine, t (112), p = 0.037
Fentanyl was better on attenuation of hemodynamic pressor responses to laryngoscopic intubation when compared to lidocaine
Summary
Manipulation of the airway is one of the most stressing moments of general anesthesia. The mean blood pressure and heart rate are increased by 30% and 22% respectively from baseline values during laryngoscopic intubation [7] These changes are only short-lived and of few consequence in healthy individuals, they may have detrimental effects on the coronary or cerebral circulation of high-risk patients [8]. There are many studies done in different countries which compare the effect of intravenous fentanyl with lidocaine as part of anesthetics adjuvant on attenuation of hemodynamic pressor responses to laryngoscopic intubation but there are conflicting results [9] [10] [11] [12]. The primary outcome of this study is to compare the post-intubation hemodynamic parameters (heart rate and blood pressure) between fentanyl and lidocaine group for attenuation of pressor responses during intubation. The secondary outcomes are to compare the baseline hemodynamic parameters with post-intubation hemodynamic parameters in each group
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