Effects of Fentanyl‐lidocaine‐propofol and Dexmedetomidine‐lidocaine‐propofol on Tracheal Intubation Without Use of Muscle Relaxants

Abstract

The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 mg/kg dexmedetomidine (Group D, n = 30) or 2 mg/kg fentanyl (Group F, n = 30), both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05). The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01). Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05). Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05). After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05). We conclude that endotracheal intubation was better with the dexmedetomidine-lidocaine-propofol combination than with the fentanyl-lidocaine-propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine.

Anestesia venosa total livre de opioides, com infusões de propofol, dexmedetomidina e lidocaína para colecistectomia laparoscópica: estudo prospectivo, randomizado e duplo‐cego

“…31 A combinação de dexmedetomidina, lidocaína e propofol foi definida para a intubação traqueal sem o uso de relaxantes musculares e resultou em condições de intubação estatisticamente mais satisfatórias em comparação com fentanil. 32 Porém, o efeito analgésico da combinação de dexmedetomidina e lidocaína em anestesia venosa total não foi avaliado antes de nosso estudo.…”

Role of Intravenous Dexmedetomidine in Prolonging Postoperative Analgesia and Quality of Block Following Spinal Anaesthesia. A Systemic Review and Update

“…Dexmedetomidine is increasingly used as an adjunct to various regional techniques [3][4][5][6][7][8]. There are studies on its successful use to facilitate laryngoscopic endotracheal intubation without using muscle relaxant [9,10], and fiber optic guided intubation [11].…”

Effect of dexmedetomidine on endotracheal intubating conditions during endotracheal intubation without neuromuscular blocker following propofol/remifentanil

“…Hanci et al [25] reported that the incidence of airway reflexes, such as coughing, and diaphragmatic movement during endotracheal intubation without a neuromuscular blocker was lower in patients administered propofol and dexmedetomidine than in patients administered propofol and fentanyl. In addition, it has been found in animal and human studies that  2 agonists such as dexmedetomidine attenuate airway constriction [26,27].…”