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Indian Journal of Clinical Anaesthesia


“Attenuation of hemodynamic response to laryngoscopy and endotracheal intubation - comparison of fentanyl, esmolol and metoprolol” in normotensive individuals


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Author Details: Pratheeba N, Remadevi R, Ravindra Bhat R, Sanjeev Kumar B

Volume : 4

Issue : 1

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 88

Article End Page : 93


Abstract

Introduction: Direct laryngoscopy and endotracheal intubation is an intrinsic component of general anaesthetic technique. It is a powerful stimulus which may evoke a plethora of sympathoadrenal stress responses. Various methods have been tried to attenuate the hemodynamic response. The objective of this study is to compare the effects of fentanyl, metoprolol, esmolol on the hemodynamic response during laryngoscopy and endotracheal intubation in normotensive individuals.
Methods: These 120 patients were randomly divided into 4 groups (F, M, E and S) to receive either the test drug or the control. GROUP F received fentanyl 1µg kg-1, GROUP M received Metoprolol 25µg kg-1, GROUP E received Esmolol 100µg kg-1 and GROUP S received saline to determine which drug best attenuated the pressor response to laryngoscopy and endotracheal intubation. Baseline heart rate and blood pressure were recorded during laryngoscopy, endotracheal intubation and up to 10 minutes prior to surgery.
Results: Esmolol effectively reduced the increase in heart rate when given half a minute prior to laryngoscopy and endotracheal intubation. Fentanyl effectively reduced the increase in mean arterial pressure only after 3 minutes of laryngoscopy and endotracheal intubation (LETI). Metoprolol 25µg kg-1 produced a gradual reduction in heart rate and mean arterial pressure only after minutes of laryngoscopy making it ineffective for the same purpose.
Conclusion: We conclude that esmolol and fentanyl can be safely used to attenuate the pressor response during laryngoscopy and intubation. Fentanyl may be used to attenuate pressor response in patient whom β-blockers are contraindicated like patients with second and third degree heart block, congestive heart failure, acute bronchospasm, and other hemodynamic instability.

Keywords:
Hemodynamic response, Esmolol, Metoprolol, Fentanyl, Intubation, Laryngoscopy