Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 236-243

Comparison of dexmedetomidine and fentanyl for attenuation of the hemodynamic response to laryngoscopy and tracheal intubation


Department of Anesthesia, Jawaharlal Nehru Medical College, Wardha, India

Date of Submission09-Nov-2014
Date of Acceptance04-Mar-2015
Date of Web Publication8-May-2015

Correspondence Address:
Vaibhav Jain
Department of Anesthesia, Jawaharlal Nehru Medical College, Wardha - 442 001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-7934.156699

Rights and Permissions
  Abstract 

Background
The pressor response, which is part of a huge spectrum of stress responses, results from the increase in sympathetic and sympathoadrenal activity. This study was conducted to compare the efficacy of dexmedetomidine and fentanyl for attenuation of largyngoscopic pressor response.
Patients and methods
Sixty patients of ASA I and II were randomly divided into two groups. Group D patients received an injection of dexmedetomidine at a dose of 1 μg/kg, whereas group F patients received an injection of fentanyl at a dose of 2 μg/kg preoperatively over 10 min before induction of anesthesia with an injection of thiopentone and vecuronium. After laryngoscopy, anesthesia was maintained with isoflurane (0.6% v/v)+N 2 O (50%)+O 2 (50%). Intraoperatively, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MBP), SpO 2 , and ECG were recorded at the following intervals: at baseline, after drug administration (at 2, 5, and 8 min), before induction, after induction, and after laryngoscopy.
Results
Dexmedetomidine significantly attenuated the sympathetic response to laryngoscopy and intubation in terms of heart rate, systolic blood pressure, and diastolic blood pressure compared with fentanyl. The total dose of thiopentone for induction of general anesthesia was significantly less in the dexmedetomidine group as compared with the fentanyl group. Incidence of bradycardia and hypotension was higher in patients of the dexmedetomidine group when compared with the fentanyl group.
Conclusion
An intravenous infusion of dexmedetomidine at 1 μg/kg administered 10 min before laryngoscopy and endotracheal intubation can be recommended over fentanyl at 2 μg/kg to attenuate the sympathetic response to laryngoscopy and endotracheal intubation with minimal side effects.

Keywords: dexmedetomidine, fentanyl, laryngoscopic pressor response


How to cite this article:
Jain V, Chandak A, Ghosh A, Golhar M. Comparison of dexmedetomidine and fentanyl for attenuation of the hemodynamic response to laryngoscopy and tracheal intubation. Ain-Shams J Anaesthesiol 2015;8:236-43

How to cite this URL:
Jain V, Chandak A, Ghosh A, Golhar M. Comparison of dexmedetomidine and fentanyl for attenuation of the hemodynamic response to laryngoscopy and tracheal intubation. Ain-Shams J Anaesthesiol [serial online] 2015 [cited 2021 Apr 20];8:236-43. Available from: http://www.asja.eg.net/text.asp?2015/8/2/236/156699


  Introduction Top


The circulatory response to laryngeal and tracheal stimulation following laryngoscopy and intubation was documented by Reid and Brace [1] in 1940 and by King et al. [2] in 1951. The pressor response, which is part of a huge spectrum of stress responses, results from the increase in sympathetic and sympathoadrenal activity, as evidenced by increased plasma catecholamine concentration in patients undergoing surgery under general anesthesia. To blunt this pressor response, various nonpharmacological and pharmacological agents have been tried.

A basic need is continuously felt among the anesthesiologist fraternity for the desired availability of a drug that effectively suppresses all hazardous responses to obnoxious stimuli with a maximum safety margin. With emphasis on the multidimensional features of dexmedetomidine and a very reputed drug, fentanyl, we designed a cross-sectional, prospective, observational study to compare the efficacy of dexmedetomidine and fentanyl for attenuation of the hemodynamic response to laryngoscopy and endotracheal intubation.


  Patients and methods Top


After prior permission from the institutional ethical committee at Acharya Vonoba Bhave Rural Hospital (Wardha), 60 patients of ASA grade I and II, aged 20-60 years, posted for surgery under general anesthesia were selected and randomly divided into two groups using 'slips of paper in a box' technique. Patients with anticipated difficult intubation and patients with a history of hypertension, cerebrovascular disease, ischemic heart disease, arrhythmias, shock, and chronic obstructive pulmonary disease (COPD) and patients requiring laryngoscopy for a duration longer than 15 s and with multiple attempts were excluded from the study.

All patients were assessed as per the routine preanesthetic check protocol. After taking informed written consent, all patients included were kept nil per oral (NPO) since midnight.

After the patient was taken inside the operation theatre preoperative baseline vital parameters were recorded. Subsequently, intravenous access was established and Ringer lactate at a rate of 10 ml/kg was started. All patients were premedicated with injection of midazolam 0.02 mg/kg intravenously 3 min before induction, and with the study drugs as follows:

  1. Group D was injected with dexmedetomidine at 1 μg/kg body weight diluted in 20 ml normal saline.
  2. Group F was injected with fentanyl at 2 μg/kg body weight diluted in 20 ml normal saline.
The study drugs were administered intravenously over 10 min using an infusion pump before induction of anesthesia. After denitrogenation with 100% O 2 , general anesthesia was induced with thiopentone sodium 2.5%, until loss of eyelash reflex, and with intravenous vecuronium bromide 0.1 mg/kg to facilitate endotracheal intubation.

Thereafter, laryngoscopy and intubation was performed by an expert anesthesiologist. Only a single attempt at intubation that could be accomplished within 15 s was accepted in the study. After intubation, patients were maintained with isoflurane (0.6% v/v)+N 2 O (50%)+O 2 (50%) and nondepolarizing muscle relaxant injection of vecuronium bromide 0.02 mg/kg given intermittently.

Incision was allowed after 15 min of intubation. At the end of the surgical procedure, the residual neuromuscular blockade was antagonized and extubation was performed after fulfilling the criteria for routine 'awake extubation' [3] .

Intraoperatively, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), MBP, SpO 2 , and ECG were recorded at the following intervals: at baseline, after drug administration (at 2, 5, and 8 min), before induction, after induction, and after laryngoscopy (1, 2, 5, 10, and 15 min).

Patients were observed postoperatively for 24 h for any complications.

Statistical analysis

A sample size of 60 was selected to detect an intergroup difference of at least 10% in blood pressure and HR with a power of 0.80 and α of 0.05. Statistical analysis was performed by descriptive and inferential statistics using the χ2 -test and Student's unpaired t-test, using IBM SPSS (version 17.0; IBM, New York, USA) and GraphPad Prism (version 5.0; GraphPad Software Inc., California, USA). P-values less than 0.05 were considered statistically significant.


  Results Top


Both groups were comparable and there was no statistically significant difference with regard to mean age, weight, sex distribution, and duration of surgery ([Table 1]).
Table 1 Demographic profi le

Click here to view


In the fentanyl group, the mean dose of thiopentone required for induction was 283.33 ± 6.70 mg (4.71 mg/kg body weight) and in the dexmedetomidine group the requirement was 143.50 ± 23.67 mg (2.53 mg/kg body weight), demonstrating a reduction of 2.18 mg/kg body weight, which is statistically highly significant (P = 0.00, t = 17.51) ([Table 2] and [Figure 1]).
Figure 1: Hemodynamic parameters. AI, after induction; BI, before induction; DBP, diastolic blood pressure; MAP, mean arterial pressure; SBP, systolic blood pressure.

Click here to view
Table 2 Dose of thiopentone and duration of surgery

Click here to view


In group D (dexmedetomidine), the mean baseline HR was 77.80 ± 7.66 bpm. Following administration of the study drug dexmedetomidine, the mean HR started declining gradually. After intubation there was a further decrease in the mean HR values from the postinduction/prelaryngoscopic values by 0.7 bpm at 1 min, by 1.73 bpm at 2 min, by 3.1 bpm at 5 min, by 4.56 bpm at 10 min, and by 4.7 bpm at 15 min. However, at no point in time during the postintubation period did the mean HR increase above the baseline mean HR value of the study population in this group. The maximum increase in HR was observed at 1 min after laryngoscopy and intubation compared with postinduction/prelaryngoscopic values.

In group F (fentanyl), the mean baseline HR was 80.90 ± 7.94 bpm. Following administration of the study drug fentanyl, the mean HR started declining gradually. After intubation there was an increase in mean HR values from the postinduction/prelaryngoscopic values by 3.43 bpm at 1 min and by 2.27 bpm at 2 min. Following that, the mean HR started declining by 2 bpm at 5 min, by 6.17 bpm at 10 min, and by 8.37 bpm at 15 min. The maximum increase in HR was observed at 1 min after intubation, compared with postinduction/prelaryngoscopic values ([Table 3]).
Table 3 Comparison of mean heart rate at different time intervals in the dexmedetomidine and fentanyl groups

Click here to view


In group D, the mean baseline SBP was 121.26 ± 8.32 mmHg. Following administration of the study drug dexmedetomidine, the mean SBP started declining gradually. After intubation there was an increase in mean SBP from the postinduction/preintubation values by 2.16 mmHg at 1 min and by 0.06 mmHg at 2 min. Following that, the mean SBP declined by 5.4 mmHg at 5 min, by 8.44 mmHg at 10 min, and by 8.97 mmHg at 15 min. The maximum increase in SBP was at 1 min after intubation, as a result of pressor response to laryngoscopy and endotracheal intubation.

In group F the mean baseline SBP was 122.10 ± 6.97 mmHg. Following administration of the study drug fentanyl, the mean SBP started declining gradually. After intubation there was an increase in mean SBP values from the postinduction/prelaryngoscopic values by 17.4 mmHg at 1 min, by 18.17 mmHg at 2 min, by 10.7 mmHg at 5 min, by 6 mmHg at 10 min, and by 3.6 mmHg at 15 min. The maximum increase in SBP was at 2 min after intubation, representing laryngoscopic pressor response ([Table 4]).
Table 4 Comparison of mean systolic blood pressure at different time intervals in patients of fentanyl and dexmedetomidine group

Click here to view


In group D (dexmedetomidine), the mean baseline DBP was 78.73 ± 8.29 mmHg. Following administration of the study drug dexmedetomidine, the mean SBP started declining gradually. After intubation, there was an increase in the mean DBP values from the postinduction/prelaryngoscopic values by 12.47 mmHg. The postintubation mean DBP values at 2, 5, 10, and 15 min showed a fall by 5.43, 7.65, 8.66, and 8.5 mmHg, respectively, from the postinduction/prelaryngoscopic values. The maximum increase in DBP was at 1 min after intubation, representing laryngoscopic pressor response.

In group F (fentanyl), the mean baseline DBP was 75.40 ± 4.98 mmHg. Following administration of the study drug fentanyl, the mean SBP started declining gradually, as recorded at specified time intervals until laryngoscopy. After intubation there was an increase in mean DBP from the postinduction/prelaryngoscopic values by 20.1 mmHg at 1 min, by 9.47 mmHg at 2 min, by 3.27 mmHg at 5 min, 1.2 mmHg at 10 min, and 1.23 mmHg at 15 min. After intubation the mean DBP was constantly higher for 15 min as compared with the mean DBP value. The highest increase in DBP was seen at 1 min after intubation, signifying the pressor response to laryngoscopy ([Table 5]).
Table 5 Comparison of mean diastolic blood pressure at different time intervals in the fentanyl and dexmedetomidine groups

Click here to view


In group D (dexmedetomidine), the mean baseline mean arterial pressure (MAP) was 92.91 ± 6.17 mmHg. Following administration of the study drug dexmedetomidine, the mean MAP started declining gradually. After intubation there was an increase in the mean MAP from the postinduction/prelaryngoscopic values by 9.04 mmHg at 1 min. Following that, the mean MAP values declined from postinduction/preintubation by 3.6 mmHg at 2 min, by 6.91 mmHg at 5 min, by 8.59 mmHg at 10 min, and by 8.65 mmHg at 15 min. The maximum increase in MAP was at 1 min after intubation, representing the hemodynamic response to laryngoscopy.

In group F (fentanyl), the mean baseline MAP was 90.96 ± 4.32 mmHg. Following administration of the study drug fentanyl, the mean MAP started declining gradually. After intubation there was an increase in the mean MAP from the postinduction/prelaryngoscopic values by 19.2 mmHg at 1 min, 12.36 mmHg at 2 min, 5.74 mmHg at 5 min, 2.8 mmHg at 10 min, and 2.02 mmHg at 15 min. The maximum increase in mean MAP was at 1 min after intubation, signifying a significant laryngoscopic pressor response ([Table 6]).
Table 6 Comparison of mean arterial pressure at different time intervals with baseline value in the fentanyl
and dexmedetomidine groups


Click here to view


The rate product is the product of SBP and HR. The maximum elevation in rate pressure product occurred at 1 min after laryngoscopy and intubation in the fentanyl group, with a figure of 9758.43, which was statistically higher than that of the dexmedetomidine group with mean rate pressure product of 8185.96 at 1 min after laryngoscopy ([Figure 2]).
Figure 2: Rate pressure product. AI, after induction; BI, before induction.

Click here to view


In the dexmedetomidine group, one patient developed hypotension, which was 25 min after intubation, and three patients had bradycardia, which was 30 min after drug administration. One patient required an injection of atropine for bradycardia, and no patient required vasopressors for correction of blood pressure. Hypotension was managed by decreasing volatile anesthetic concentration and infusing intravenous fluids. No side effects were noted in group F ([Figure 3] and [Table 7]).
Figure 3: Side effects.

Click here to view
Table 7 Side effects in both groups

Click here to view



  Discussion Top


Laryngoscopy and tracheal intubation are considered the most critical events during administration of general anesthesia as they provoke transient but marked sympathoadrenal response manifesting as hypertension and tachycardia [4] .

These responses are transitory and variable and may not be significant in otherwise normal individuals. However, in patients with cardiovascular compromise like hypertension, ischemic heart disease, and cerebrovascular disease and in patients with intracranial aneurysms, even these transient changes in hemodynamics can result in potentially deleterious effects. These are by far the most important indications for attenuation of hemodynamic response to laryngoscopy and tracheal intubation [2] .

Many methods like the use of inhalational anesthetic agents, lidocaine [5],[6] , opioids, direct-acting vasodilators [7],[8] , calcium-channel blockers [9],[10] , and β-blockers [11],[12] have been tried by various authors for blunting hemodynamic responses to laryngoscopy and intubation. However, all such maneuvers had limitations. The search for the ideal technique or agents for attenuation of hemodynamic changes is still continuing.

Fentanyl

Fentanyl is advocated for attenuation of sympathetic response to laryngoscopy and intubation [13],[14],[15],[16],[17],[18],[19] . Blunting of sympathetic response is dose dependent [20] . At high doses, fentanyl produces tissue accumulation and thus patients may require mechanical respiratory support [16] . Fentanyl at 6 μg/kg completely abolishes, whereas at 2 μg/kg significantly attenuates, arterial pressure and HR increase during laryngoscopy and intubation [15] . In this study, fentanyl was given at the dose of 2 μg/kg diluted in 20 ml normal saline over 10 min, 10 min induction [21],[22] .

Dexmedetomidine

In the present study dexmedetomidine was given as intravenous infusion 1 μg/kg in 20 ml normal saline over 10 min. Rapid administration of a bolus dose of dexmedetomidine results in an initial transient increase in blood pressure and reflex decrease in HR because of peripheral α-2 adrenoceptor stimulation of vascular smooth muscle. Hence in the present study dexmedetomidine was administered over 10 min [21],[22],[23],[24],[25] .

It has been proven beyond clinical doubt that dexmedetomidine and fentanyl as premedication attenuates the hemodynamic response to laryngoscopy and endotracheal intubation. Hence, we thought it would be appropriate to compare the effectiveness of the two drugs for attenuation of the pressor response to laryngoscopy and endotracheal intubation.

Hemodynamic changes

Heart rate

Comparison between the mean HR values of patients in the two groups demonstrated that there was no statistically significant difference until induction of anesthesia (P > 0.05). The increase in mean HR after administration of thiopentone was statistically lower in group D as compared with group F. Analysis of the postinduction, postintubation values of the mean HR variation from the baseline values of the two groups showed a statistically significant difference until 10 min (P < 0.05). However, the mean HR values at 15 min after intubation were comparable to each other, demonstrating no statistically significant difference (P > 0.05).

In a study conducted by Patel et al. [26] , it was observed that dexmedetomidine significantly attenuates stress response at intubation with lower increase in HR (10%) as compared with fentanyl (17%). This is in contrast with our study, in which HR decreased in the dexmedetomidine group.

This is in contrast with the results of Gandhi et al. [21] , who observed that the HR increased after laryngoscopy and intubation in both groups and it started to return to near normal values at the end of 10 min after intubation. The authors also observed that the increase in HR was highly significant in the fentanyl group as compared with dexmedetomidine during laryngoscopy and after intubation.

Kharwar et al. [22] observed that there was a decrease in pulse rate from baseline by 17.80% in the dexmedetomidine group as compared with the fentanyl group, in which the decrease was 6.99% from baseline after induction. At 1 min after intubation, they observed an increase in HR of 09.85% from baseline in the fentanyl group and decrease of 7.03% from baseline in the dexmedetomidine group, which is in concordance with our study.

The observations of our study demonstrate that dexmedetomidine completely abolishes the chronotropic response to laryngoscopy and intubation compared with fentanyl.

Systolic blood pressure

Comparison between the two groups demonstrated that there was no statistically significant difference between the mean SBP values of the two groups up to 8 min after study drug administration. Analysis of preinduction and postinduction values of the mean SBP variations as compared with the baseline values in the two groups showed a statistically significant difference (P < 0.05). At 1 min after intubation, mean SBP showed no statistically significant difference between the two groups (P > 0.05). The mean SBP comparison at 2, 5, and 10 min after intubation demonstrated significant differences between the two groups (P < 0.05). At 15 min after intubation, the mean SBP values were comparable in the two groups (P > 0.05).

In the study conducted by Patel et al. [26] , it was observed that dexmedetomidine significantly attenuates stress response at intubation with lower increase in SBP (6%) compared with fentanyl (23%). This is similar to our study, in which SBP decreased in the dexmedetomidine group.

Gandhi et al. [21] observed that dexmedetomidine produces more significant attenuation of increase in SBP during laryngoscopy and intubation as compared with fentanyl, which is in concordance with our study.

Diastolic blood pressure

Comparison between the two groups demonstrated that there was no statistically significant difference in the mean baseline DBP values. The preinduction mean DBP values were statistically significantly different between the two groups (P < 0.05). Postinduction mean DBP showed a comparable increase, which was statistically not significant. Postlaryngoscopic comparison of the mean DBP values showed a statistically significant variation in mean DBP values at 1, 2, 5, 10, and 15 min, demonstrating better suppression of the pressor response to intubation.

In a study conducted by Patel et al. [26] , it was observed that dexmedetomidine leads to lower increase in HR (7%) compared with fentanyl (20%). This is similar to our study, in which HR decreased in the dexmedetomidine group.

Our study is in concordance with that of Gandhi et al. [21] , who observed a significant increase in DBP during laryngoscopy and endotracheal intubation in the fentanyl group compared with the dexmedetomidine group (P < 0.001).

Mean arterial pressure

Comparison between the two groups demonstrated that there was no statistically significant difference between the mean baseline MAP values of the two groups. The postlaryngoscopic mean MAP values showed a statistically significant difference between the two groups, with intravenous dexmedetomidine group at 1, 2, 5, 10, and 15 min demonstrating better suppression of the pressor response to intubation.

With respect to MAP, our study results are similar to those of various investigators [21],[27],[28] .

Dose of thiopentone required for induction

This difference can be explained by the anesthetic-sparing effects of dexmedetomidine [27],[29] .

Various investigators have confirmed the statistically significant reduction in the induction dose of thiopentone in the dexmedetomidine group [29],[30],[31],[32] .

The anesthetic-sparing effect of dexmedetomidine is due to a decrease in central noradrenergic transmission and also due to α-2 receptor specificity mediating analgesic and sedative properties.

Side effects

Our study is in concordance with that of Kharwar et al. [22] who observed hypotension and bradycardia in patients in the dexmedetomidine group, whereas no side effects were observed in the fentanyl group. However, postoperatively patients in both groups had nausea and vomiting, which is in contrast with our study.

On using equipotent doses of fentanyl and dexmedetomidine, we found that dexmedetomidine significantly attenuated the sympathetic response to laryngoscopy and intubation in terms of HR, SBP, and DBP, compared with fentanyl.

  1. The mean rate pressure product was below 12 000 in both groups, being significantly lower in group D.
  2. The total dose of thiopentone for induction of general anesthesia was significantly lower in the dexmedetomidine group compared with the fentanyl group.
  3. Incidence of bradycardia and hypotension was higher in patients of the dexmedetomidine group compared with the fentanyl group, which was managed easily.

  Conclusion Top


This study demonstrates that dexmedetomidine is superior to fentanyl for attenuation of hemodynamic response and for reducing the total dose of the inducing agent.

An intravenous infusion of dexmedetomidine at 1 μg/kg administered 10 min before laryngoscopy and endotracheal intubation can be recommended over fentanyl 2 μg/kg to attenuate the sympathetic response to laryngoscopy and endotracheal intubation with minimal side effects.


  Acknowledgements Top


Conflicts of interest

There are no confl icts of interest.

 
  References Top

1.
Reid LC, Brace DE. Irritation of the respiratory tract and its reflex effect upon heart. Surg Gynaecol Obstet 1940; 70:157-162.  Back to cited text no. 1
    
2.
King BD, Harris LC Jr, Greifenstein FE, Elder JD Jr, Dripps RD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology 1951; 12: 556-566.  Back to cited text no. 2
    
3.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R. Clinical anesthesia. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.  Back to cited text no. 3
    
4.
Prys-Roberts C, Greene LT, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension-II. Hemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971; 43:541-547.  Back to cited text no. 4
    
5.
Donlinger JK, Ellison N, Ominsky AJ. Effects of intrathecal lidocaine on circulatory responses to tracheal intubation. Anaesthesiology 1974; 41:409-412.  Back to cited text no. 5
    
6.
Stoelting RK. Blood pressure and heart rate changes during short-duration laryngoscopy for tracheal intubation: influence of viscous or intravenous lidocaine. Anesth Analg 1978; 57:197-199.  Back to cited text no. 6
    
7.
Stoelting RK. Attenuation of blood pressure response to laryngoscopy and tracheal intubation with sodium nitroprusside. Anesth Analg 1979; 58:116-119.  Back to cited text no. 7
    
8.
Fassoulaki A, Kaniaris P. Intranasal administration of nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea. Br J Anaesth 1983; 55:49-52.  Back to cited text no. 8
    
9.
Nishikawa T, Naiki A. Attenuation of pressor response to laryngoscopy and tracheal intubation with IV verapamil. Acta Anesthesiol Scand 1989; 33:232-235.  Back to cited text no. 9
    
10.
Fuji Y, Tanaka H, Saitoh Y, Toyooka H. Effects of Calcium channel blockers on circulatory response to tracheal intubation in hypertensive patients: nicardipine versus diltiazem. Can J Anaesth 1995; 42:785-788.  Back to cited text no. 10
    
11.
Prys-Roberts C, Foëx P, Biro GP, Roberts JG. Studies of anaesthesia in relation to hypertension. V. Adrenergic beta-receptor blockade. Br J Anaesth 1973; 45:671-681.  Back to cited text no. 11
    
12.
Chung KS, Sinatra RS, Chung JH. The effect of an intermediate dose of labetalol on heart rate and blood pressure responses to laryngoscopy and intubation. J Clin Anesth 1992; 4:11-15.  Back to cited text no. 12
    
13.
Bachofen M. Suppression of blood pressure increases during intubation: lidocaine or fentanyl?. Anaesthesist 1988; 37:156-161.  Back to cited text no. 13
    
14.
Ko SH, Kim DC, Han YJ, Song HS. Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation. Anesth Analg 1998; 86: 658-661.  Back to cited text no. 14
    
15.
Kautto UM. Attenuation of the circulatory response to laryngoscopy and intubation by fentanyl. Acta Anaesthesiol Scand 1982; 26:217-221.  Back to cited text no. 15
    
16.
Judd LK, Theodore S, John E, Lynn W, Andrew W. High dose fentanyl anaesthesia for coronary artery surgery: plasma fentanyl concentrations and influence of nitrous oxide on cardiovascular responses. Anesth Analg 1979; 58:390-393.  Back to cited text no. 16
    
17.
Martin DE, Rosenberg H, Aukburg SJ, Bartkowski RR, Edwards MW Jr, Greenhow DE, Klineberg PL. Low-dose fentanyl blunts circulatory responses to tracheal intubation. Anesth Analg 1982; 61:680-684.  Back to cited text no. 17
    
18.
Splinter WM, Cervenko F. Haemodynamic responses to laryngoscopy and tracheal intubation in geriatric patients: effects of fentanyl, lidocaine and thiopentone. Can J Anaesth 1989; 36:370-376.  Back to cited text no. 18
    
19.
Adachi YU, Satomoto M, Higuchi H, Watanabe K. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anesth Analg 2002; 95:233-237, table of contents.  Back to cited text no. 19
    
20.
Giesecke K, Hamberger B, Järnberg PO, Klingstedt C, Persson B High- and low-dose fentanyl anaesthesia: hormonal and metabolic responses during cholecystectomy. Br J Anaesth 1988; 61:575-582.  Back to cited text no. 20
    
21.
Gandhi S, Goyal V, Radhkrishnan K, Balakrishnan M. Comparison of Dexmedetomidine with fentanyl in attenuation of pressor response during laryngoscopy and intubation. IOSR J Pharm 2014; 4:28-38.  Back to cited text no. 21
    
22.
Kharwar RK, Kumar R, Tiwary PK, Suwalka U, Prakash S. A comparison of intravenous dexmedetomidine v/s inj. fentanyl for attenuation of hemodynamic responses during laryngoscopy and intubation after propofol induction. NJIRM 2014; 5:71-75.  Back to cited text no. 22
    
23.
Mowafi HA, Aldossary N, Ismail SA, Alqahtani J. Effect of dexmedetomidine premedication on the intraocular pressure changes after succinylcholine and intubation. Br J Anaesth 2008; 100:485-489.  Back to cited text no. 23
    
24.
Sagiroglu AE, Celik M, Orhon Z, Yuzer S, Sen B. Different doses of dexmedetomidine on controlling haemodynamic responses to tracheal intubation. Int J Anaesthesiol 2010; 27:2.  Back to cited text no. 24
    
25.
Pal CK, Ray M, Sen A, Hajra B, Mukherjee D, Ghanta AK. Changes in intraocular pressure following administration of suxamethonium endotracheal intubation: influence of dexmedetomidine premedication. Indian J Anaesth 2011; 55:573-577.  Back to cited text no. 25
[PUBMED]  Medknow Journal  
26.
Patel CR, Engineer SR, Shah BJ, Madhu S. Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: a study with entropy analysis. Indian J Anaesth 2012; 56:542-546.  Back to cited text no. 26
[PUBMED]  Medknow Journal  
27.
Bajwa SJ, Kaur J, Singh A, Parmar S, Singh G, Kulshrestha A, et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian J Anaesth 2012; 56:123-128.  Back to cited text no. 27
[PUBMED]  Medknow Journal  
28.
Turgut N, Turkmen A, Gökkaya S, Altan A, Hatiboglu MA. Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy. Minerva Anestesiol 2008; 74:469-474.  Back to cited text no. 28
    
29.
Khanduja S, Ohri A, Panwar M. Dexmedetomidine decreases requirement of thiopentone sodium and pentazocine followed with improved recovery in patients undergoing laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2014; 30:208-212.  Back to cited text no. 29
[PUBMED]  Medknow Journal  
30.
Jaakola ML, Ali-Melkkila T, Kanto J, Kallio A, Scheinin H, Scheinin M. Dexmedetomidine reduces intraocular pressure, intubation response and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth 1992; 68:570-575.  Back to cited text no. 30
    
31.
Aantaa R, Kanto J, Scheinin M, Kallio A, Scheinin H. Dexmedetomidine, an alpha 2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology 1990; 73:230-235.  Back to cited text no. 31
    
32.
Basar H, Akpinar S, Doganci N, Buyukkocak U, Kaymak C, Sert O, et al. The effect of preanaesthetic, single dose dexmedetomidine on induction, haemodynamic and cardiovascular parameters. J Clin Anaesth 2008; 20:431-436.  Back to cited text no. 32
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


This article has been cited by
1 COMPARATIVE STUDY OF DEXMEDETOMIDINE AND FENTANYL ON HAEMODYNAMIC RESPONSES DURING LARYNGOSCOPY AND PNEUMOPERITONEUM IN LAPAROSCOPIC CHOLECYSTECTOMY
Niladri Sekhar Mukhopadhyay,Saunak Nath,Saurendra Nath Mitra,Debarshi Jana
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH. 2021; : 52
[Pubmed] | [DOI]
2 COMPARISON OF DEXMEDETOMIDINE WITH FENTANYL IN ATTENUATION OF PRESSOR RESPONSE TO LARYNGOSCOPY AND INTUBATION
Sumathi Natta,Preethi Dasari,Deepraj Singh B
Journal of Evidence Based Medicine and Healthcare. 2017; 4(54): 3281
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  Patients and methods
  Results
  Discussion
  Conclusion
  Acknowledgements
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed3164    
    Printed67    
    Emailed0    
    PDF Downloaded473    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]