Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray

Abstract

Background: Laryngoscopy and tracheal intubation is invariably associated with certain cardiovascular changes such as tachycardia, rise in blood pressure and a wide variety of cardiac arrhythmias. 1 Such complications are highly detrimental in patients with limited cardiovascular reserve specially in geriatric and elderly population. Various pharmacological agents have been used to attenuate these stress responses but none has yet been considered ideal. Therefore, purpose of this study is to investigate the efficacy of sublingual Nitroglycerine spray alone and sublingual Nitroglycerine spray with intravenous Fentanyl to attenuate the pressor response to laryngoscopy and intubation in normotensive patients.Methods: A total of 120 ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into 3 groups of 40 in each group. Group 1 control group, Group 2, received NTG sub-lingual spray (0.4mg/spray) two min. before induction, and Group 3 received inj. Fentanyl (2µg/kg) 5min before + NTG sub-lingual spray (0.4 mg/spray) 2min before induction. Vital parameters before and after induction and thereafter at specified time interval following laryngoscopy and intubation were recorded for comparison.Results: Demographic characteristics and baseline vital parameters in both the groups were comparable. Significant differences in mean arterial pressure (MAP) and heart rate (HR) were observed in between the groups during postintubation period.Conclusions: Combination of intravenous Fentanyl plus Nitroglycerin spray is more effective than NTG alone in attenuating the stress response following laryngoscopy and intubation.