Comparison of intravenous fentanyl versus lidocaine for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing elective surgery in Dilla University Referral Hospital, Ethiopia, a randomized controlled trial

Abstract

Background: Laryngoscopy and endotracheal intubation is one of the most stressing moments in technique of general anesthesia. It can cause pressure response and sympato adrenal response due to stimulation of epipharynx and laryngopharynx. The main objective of this study is to compare the effect of intravenous lidocaine and fentanyl for attenuation of hemodynamic response during laryngoscopy and intubation in elective patients who undergo general anesthesia with endotracheal intubation. Methods: A randomized controlled trial was conducted in 52 eligible adults allocated in to 2 group; group F (n=26) patients received fentanyl 2 mcg/kg and group L (n=26) patients received lidocaine (2%) 1.5 mg/kg. The hemodynamic variables were recorded at 1st, 3rd, 5th, and 10th minutes after laryngoscopy and intubation. Kolmogorov test were used to test for distributions of data while homogeneity of variance were assessed using Levene test for equality of variance. Between groups comparison of vital sign were made using independent t test symmetric data and Mann-Whitney U test was used for asymmetric data. A post hoc effect size calculated using G-power. Those variables with P-value <0.05 were considered as statistically significant. Result: The mean rise in heart rate from base line was higher in lidocaine group 29.26±15.02 bpm compared with fentanyl group 17.56±10.28 bpm at first minute. The mean rise in systolic blood pressure from base line at first minute is lower in fentanyl group 17.53±13.04 compared with lidocaine group 31.53±17.24. The mean rise in hemodynamic variables (heart rate, systolic blood pressure, means arterial pressure, and diastolic blood pressure) from base line at 3rd, 5th, and 10th were comparable between groups with (P-value >0.05). Conclusion and Recommendation: Fentanyl at 2 µg/kg is superior in attenuation of hemodynamic response to laryngoscopy and intubation at first minute. There is comparable hemodynamic attenuation effect between groups at 3rd, 5th, and 10th minutes after intubation. Based on this we recommended that use of fentanyl 2 µg/kg better blunt hemodynamic response at first minute where both are equal at 3rd, 5th, and 10th minutes.