Dexmetomidine, fentanyl and esmolol on prevention of the hemodynamic effects of laryngoscopy and endotracheal intubation. a prospective, randomized, double-blind study

Abstract

Issue Title: ESICM LIVES 2015

Mavri et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A210 http://www.icm-experimental.com/content/3/S1/A210

POSTER PRESENTATION Open Access

Dexmetomidine, fentanyl and esmolol on prevention of the hemodynamic effects of laryngoscopy and endotracheal intubation. a prospective, randomized, double-blind study

M Mavri1, K Rellos1, I Pantazopoulos2, C Kampolis3, I Floros4, N Iacovidou5, T Xanthos6, C Pantazopoulos4*

From ESICM LIVES 2015Berlin, Germany. 3-7 October 2015

Intr

The hemodynamic effects of laryngoscopy and endotracheal intubation are well known. A variety of drugs, like fentanyl, esmolol and lately dexmetomidine, have been used in order to attenuate the stress response to laryngoscopy and endotracheal intubation. Esmolol is an ultrashort acting beta 1 selective adrenergic antagonist, while dexmetomidine is an alpha 2 adrenergic receptor agonist. Fentanyl is a short-acting opioid.

Objectives

The scientific objective of this study, was to compare the efficacy of dexmetomidine, fentanyl and esmolol for attenuation of sympathetic response during laryngoscopy and endotracheal intubation.

Methods

The present study included sixty (60) elective surgery patients with ASA 1 and 2, aged 20-60 years, who needed endotracheal intubation. Patients were randomly allocated into 3 groups. Each group included twenty patients (n = 20). Patients in group D (Dexmetomidine) received 1mcg/kg dexmetomidine with infusion in 10 min, patients in group F (Fentanyl) received 2 mcg/kg fentanyl, while in group E (Esmolol), patients received 2 mg/kg esmolol two min before induction. All patients had Mallampati and Cormack-Lehane Grades 1 or 2. All patients were intubated in less than 30 sec. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 2, 4 and 10 min after intubation.

Results

When recorded values before induction and intubation were compared to the measurements of the groups, it was found that 4 and 10 min after intubation, heart rate in group D and systolic, diastolic and mean arterial pressures in group E, were lower than the other measurements. (p < 0.05).

Conclusions

Dexmedetomidine was superior than the other drugs in preventing laryngoscopy and intubation-related tachycardia. On the other hand, esmolol was superior in preventing systolic, diastolic and mean arterial pressure increases following laryngoscopy and intubation.

Authors details

1Central Clinic of Athens, Research and Treatment Medical Center, Anaesthesiology and Intensive Care, Athens, Greece. 2Evaggelismos General Hospital of Athens, Intensive Care Unit, Athens, Greece. 3Laiko General Hospital of Athens, University of Athens, Pathophysiology Clinic, Athens, Greece. 4Laiko General Hospital of Athens, University of Athens, Intensive Care Unit, Athens, Greece. 5University of Athens, Medical School, Neonatology, Athens, Greece. 6University of Athens, Medical School, MSc Cardiopulmonary Resuscitation, Athens, Greece.

Published: 1 October 2015

References1. Yavascaoglu B, Kaya FN, Baykara M, et al: A comparison of esmolol and dexmedetomidine for attenuation of intraocular pressure and haemodynamic responses to laryngoscopy and tracheal intubation. Eur J Anaesthesiol 2008, 25:517-19.

2. Atlee JL, Dhamee MS, Olund TL, et al: The use of esmolol, nicardipine, or their combination to blunt hemodynamic changes after laryngoscopy and tracheal intubation. Anesth Analg 2000, 90:280-5.

3. Adachi YU, Satomoto M, Higuchi H, et al: Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anesth Analg 2002, 95:233-7.

4Laiko General Hospital of Athens, University of Athens, Intensive Care Unit, Athens, GreeceFull list of author information is available at the end of the article

2015 Pantazopoulos et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0

Web End =http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mavri et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A210 http://www.icm-experimental.com/content/3/S1/A210

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doi:10.1186/2197-425X-3-S1-A210Cite this article as: Mavri et al.: Dexmetomidine, fentanyl and esmolol on prevention of the hemodynamic effects of laryngoscopy and endotracheal intubation. a prospective, randomized, double-blind study. Intensive Care Medicine Experimental 2015 3(Suppl 1):A210.

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