Abstract
Aim of Study: Laryngoscopy and endotracheal intubation are the commonest method for securing a definitive airway for general anaesthesia. It is one of the most invasive and painful stimuli in anaesthesia producing clinically relevant changes in the hemodynamic variables.
 This study has been designed to compare the safety and efficacy of three different doses of fentanyl (2µg/kg, 3µg/kg and 4µg/kg) in attenuating hemodynamic response, following laryngoscopy and endotracheal intubation.
 Materials and Methods: In this observational study, three groups of 90 patients belonging to ASA grade I and II, aged between 18 to 65
 years, including either gender, posted for elective surgery under GA with informed consent. Baseline vital hemodynamic parameters and the serial heart rate, arterial pressures, SpO2 and respiratory rate were noted at five minutes after intravenous fentanyl administration, during laryngoscopy & intubation and at 1-, 3-, 5-, 10- and 20-minutes after laryngoscopy. Ramsay sedation scores were also noted at five minutes after intravenous fentanyl administration, during extubation and at 10-, 20- and 30-minutes after extubation.
 Results: There was substantial difference in mean HR, SBP, DBP & MAP values post 5 minutes after intravenous fentanyl administration, during laryngoscopy, at 1, 3-, 5-, 10- and 20-minutes following laryngoscopy and intubation between the three groups. Patients’ behaviour belonging to group C (IV fentanyl 4µg/kg), followed by the patients of group B (IV fentanyl 3µg/kg) presented considerable amount of attenuation of all the hemodynamic stress parameters effectively, with statistically significant results when compared to group A (IV fentanyl 2µg/kg).
 Conclusion: Intravenous fentanyl 4µg/kg and 3µg/kg are better at attenuating the laryngo-tracheal stress response, in comparison to intravenous fentanyl 2µg/kg.
Highlights
Intravenous fentanyl 4μg/kg and 3μg/kg are better at attenuating the laryngo-tracheal stress response, in comparison to intravenous fentanyl 2μg/kg
Laryngoscopy and endotracheal intubation are considered as strong noxious stimuli, producing clinically relevant changes in hemodynamic variables such as tachycardia and hypertension, most commonly [1,2,3]
All hemodynamic measurements like heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), SpO2 & respiratory rate (RR) were recorded at baseline, 5 minutes after intravenous fentanyl, during laryngoscopy & intubation, 1 minute, 3 minutes, 5 minutes, 10 minutes & 20 minutes after intubation
Summary
Laryngoscopy and endotracheal intubation are considered as strong noxious stimuli, producing clinically relevant changes in hemodynamic variables such as tachycardia and hypertension, most commonly [1,2,3] This hemodynamic response is precipitated via a sympathoadrenal stimulation. Sympathetic stimulation leading to raised plasma catecholamine levels during the act of laryngo-tracheal manipulation has been advocated as the major cause for this hemodynamic response [4]. It is short-lived, occurring 30 seconds after starting laryngoscopy and lasting for less than 10-15 minutes. The patients were randomized into three groups using the equal group random allocation method. Baseline vital parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), SPO2 and respiratory rate will be recorded (baseline)
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