Effect of pre-extubation low-dose fentanyl on attenuation of haemodynamic response and quality of extubation: A prospective randomised trial

Abstract

BackgroundEmergence from anaesthesia, tracheal stimulation during extubation alters the hemodynamics, and coughing generates aerosol that needs to be avoided. AimThe study aimed to evaluate the effectiveness of low doses (0.5 μg/kg) of fentanyl at the end of the surgery in attenuating hemodynamic response and extubation quality. MethodsThis prospective, randomized, double-blind trial was conducted in a tertiary care center, with a total of 70 ASA PS I&II patients scheduled for elective laparoscopic cholecystectomy. Standard protocol followed for induction of the patients. At the end of the surgery, patients were randomly allocated to either Group-F and Group-C to receive intravenous fentanyl 0.5 μg/kg or an equal volume of normal saline respectively. Hemodynamic parameters before and after the drug, at awakening, while extubation (T0), one and minutes post-extubation (T1&T5 respectively) were measured. Airway reflex scores (ARS), extubation quality score (EQS), and Ramsay sedation scores (RSS) monitored during extubation. ResultsGroup-C patients had significantly higher mean arterial pressure at T1 (P = 0.021), higher incidence of agitation at T0(P = 0.002), T1(P = 0.002), and T5 (P = 0.009). Group-F patients had significantly better ARS at T0 and T1 (P < 0.001) and better EQS (P < 0.001). ConclusionLow-dose fentanyl at the time of extubation is an effective way to achieve smooth extubation, control unstable hemodynamics and agitation.