A prospective randomized controlled trial comparing the effects of dexmedetomidine and fentanyl on attenuation of pressor response during laryngoscopy and intubation in neurosurgical patients

Abstract

Background: Laryngoscopy is associated with a sympathetic response that results in a rapid increase in blood pressure and heart rate in these patients. The mechanisms underlying these hemodynamic changes are incompletely understood. They may be caused by a reflex sympathetic discharge due to stimulation of the upper respiratory tract. It has been observed that hemodynamic responses to tracheal intubation are associated with an increase in plasma catecholamine concentrations and are attenuated by β-adrenergic blockade. These hemodynamic changes may be undesirable particularly in neurosurgical patients. Aim of the study is the present study was prospective, randomized, double-blind conducted to evaluate the efficacy of dexmdetomidine and fentanyl in attenuation of pressor responses to laryngoscopy and intubation in neurosurgical patients undergoing lumbar spine surgeries.Methods: A total of 60 patients of 18–65 years, American Society of Anaesthesiologists Class I/II of undergoing elective neurosurgical procedures were included in the study. The patients were divided into two groups of 30 patients each. Group D received dexmedetomidine and Group F received Fentanyl. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were recorded preoperatively (baseline), at 5 and 8 minutes after infusion of study drug, before induction, 1 minute after induction, 2 minute after intubation, 5 minute after intubation, 10 minute after intubation and 15 minute after intubation.Results: There was a better control of Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure in Group D when compared to Group F during laryngoscopy and after intubation.Conclusions: The present study shows that dexmedetomidine suppresses hemodynamic responses effectively than fentanyl.

Comparison of Fentanyl and Dexmedetomidine in Preventing an Increase in Heart Rate During Intubation Among Patients Undergoing General Anesthesia: A Meta-Analysis

“…Only one study compared fentanyl, dexmedetomidine, and lidocaine [11]. All other studies have compared only fentanyl and dexmedetomidine [12][13][14][15][16][17][18]. In this meta-analysis, lidocaine was ignored, as the aim of this meta-analysis was to compare fentanyl and dexmedetomidine.…”

“…neurosurgical procedure [12], and cardiac surgery [18]. All other studies included all kinds of elective surgical procedures [13][14][15][16][17].…”

“…All eight studies reported HR at baseline [11][12][13][14][15][16][17][18]. The meta-analysis results showed no significant difference in HR between the two groups at baseline (MD = 1.48; 95% CI: -0.84, 3.81; P = 0.21, I 2 = 53%), as shown in Figure 3.…”

“…The meta-analysis results showed no significant difference in HR between the two groups at baseline (MD = 1.48; 95% CI: -0.84, 3.81; P = 0.21, I 2 = 53%), as shown in Figure 3. Source: [11][12][13][14][15][16][17][18].…”

“…All eight studies compared the HR between dexmedetomidine and fentanyl after five minutes of intubation [11][12][13][14][15][16][17][18]. There was significant heterogeneity among the studies (I 2 = 84%).…”