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

Abstract

General anesthesia induction, tracheal intubation, extubation, and laryngoscopy are associated with specific hemodynamic changes. Tracheal intubation and laryngoscopy are related to sympathetic stimulation and lead to hypertension and tachycardia. Recent studies have shown that dexmedetomidine is safe and effective as it does not depress respiratory function. This meta-analysis aims to compare the efficacy of dexmedetomidine and fentanyl in preventing an increase in heart rate (HR) during intubation among patients undergoing general anesthesia. A systematic literature search was done using PubMed, Cochrane Library, and Embase to assess studies comparing the efficacy of dexmedetomidine and fentanyl in preventing an increase in HR during intubation. A meta-analysis was done utilizing a random-effects model, and mean differences of HR were determined between fentanyl and dexmedetomidine at baseline, one minute, five minutes, and 10 minutes of intubation. In this meta-analysis, eight randomized control trials were included, involving 548 patients (274 in the fentanyl group and 274 in the dexmedetomidine group). The findings showed that significant difference of HR was significantly lower in the dexmedetomidine group than the fentanyl group at one minute of intubation (mean difference = -8.46; P-value = 0.003), at five minutes of intubation (mean difference = -7.51; P-value = 0.001), and at 10 minutes of intubation (mean difference = -5.15; P-value = 0.030). In the current meta-analysis, dexmedetomidine was better than fentanyl in preventing tachycardia following endotracheal intubation. HR was significantly lower at one minute, five minutes, and 10 minutes after intubation in the dexmedetomidine group compared to the fentanyl group.

Comparison of Opioid-Based Versus Opioid-Sparing Anesthesia in Patients Undergoing Glioma Surgery

“…Earlier studies have shown that dexmedetomidine provides a blunting response during laryngoscopy, intubation, skull pinning, and extubation in various surgeries under general anesthesia, which was similar to the result of this study [1,10,[12][13][14].…”

“…Dexmedetomidine is an alpha-2 agonist, gaining popularity in neuroanesthesia as an adjuvant for its sympatholytic, sedative, and hemodynamic stabilizing properties without causing significant respiratory depression and a decrease in the need for anesthesia [7][8][9]. In one of the recent meta-analyses, dexmedetomidine was proven to be better at preventing tachycardia following endotracheal intubation than fentanyl [10].…”

Comparison of dexmedetomidine, lidocaine and fentanyl in attenuation of haemodynamic response to laryngoscopy and intubation in cardiac surgery patients

“…Hence statistically significant bradycardia was not observed in our study compared to the other two groups. Mohsin et al [10] conducted a meta-analysis of clinical trials which compared the effectiveness of dexmedetomidine and fentanyl in avoiding elevation in HR during intubation and found that HR was significantly lower at 1 min, 5min and 10 mins post intubation in dexmedetomidine group. Das et al [11] compared fentanyl and dexmedetomidine in diminution of hemodynamic response to laryngoscopy and intubation and found that dexmedetomidine had significant fall in blood pressure than fentanyl (p-value=0.03) while there was no significant fall in heart rate between dexmedetomidine and fentanyl (p-value=0.…”

Nebulized dexmedetomidine for attenuating hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing surgeries under general anaesthesia: a systematic review and meta-analysis of randomized controlled trials

“…Dexmedetomidine’s highly-selective agonistic action on presynaptic α2-adrenergic receptors and subsequent inhibition of norepinephrine release from the locus coeruleus has been hypothesized as the most putative mechanism for its hemodynamic stress response attenuating action [ 26 ]. Intravenous dexmedetomidine also attenuates the hemodynamic responses to laryngoscopy and ETI but is associated with risk of bradycardia, hypotension and cardiac arrests [ 4 , 9 , 10 , 14 , 27 , 28 ]. De Cassai et al in a recent SRMA of 99 RCTs involving 6833 patients found significant bradycardia in one out of every 12 patients [ 4 ].…”

“…Dexmedetomidine is a centrally acting α-2 adrenergic agonist with sedative, hypnotic, analgesic, anxiolytic, antisialagogue, antinociceptive and sympatholytic action [2,3]. Premedication with dexmedetomidine through intravenous, intramuscular and intranasal route has been shown to effectively attenuate hemodynamic response to laryngoscopy and ETI [4][5][6][7][8][9][10]. However, its use is associated with adverse effects like hypotension and bradycardia with intravenous route and nasal irritation with intranasal route [5][6][7][8]11].…”