| Peer-Reviewed

A Comparative Study of Fentanyl –Clonidine and Fentanyl - Lidocaine on Attenuation of Haemodynamic Stress Response to Laryngoscopy and Tracheal Intubation in Hypertensive Patients

Received: 14 October 2014     Accepted: 22 October 2014     Published: 30 October 2014
Views:       Downloads:
Abstract

Introduction: Endotracheal intubation may create a period of hemodynamic instability in normotensive patients but more so in hypertensive patients. Endotracheal intubation produces stimulation of laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines leading to hypertensive crisis. Objectives: The objective of study is to evaluate and compare the efficacy of fentanyl- clonidine and fentanyl – lidocaine combine in attenuating the stress responses to laryngoscopy and endotracheal intubation in hypertensive patients. Material and Methods: We conducted a prospective, randomized, double-blind study in 40 patients with controlled hypertension. All patients were randomly divided into two groups, fentanyl-clonidine (FC) group and fentanyl – lidocaine (FL) group. The FC group received Fentanyl 2 mcg/kg and clonidine 2mcg/kg and the FL group received lidocaine1.5mg/kg and fentanyl 2mcg/kg , 3 min prior to intubation. Hemodynamic parameters were recorded at baseline, before giving induction agents, and 1, 3 and 5 minutes after endotracheal intubation. Results: There were no significant differences between the two groups regarding hemodynamic parameters like heart rate, systolic blood pressure, diastolic and mean arterial blood pressure at before induction, 1, 3 and 5 minutes after intubation. Conclusions: Both fentanyl – clonidine and fentanyl – lidocaine combine effectively decreased the stress response to endotracheal intubation.

Published in Journal of Anesthesiology (Volume 2, Issue 4)
DOI 10.11648/j.ja.20140204.11
Page(s) 27-31
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Fentanyl, Hemodynamic Stress, Intubation, Lidocaine, Clonidine

References
[1] Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987; 59(3):295-9.
[2] Kimura A, Yamakage M, Chen X, Kamada Y, Namiki A. Use of the fibreoptic stylet scope (Styletscope) reduces the hemodynamic response to intubation in normotensive and hypertensive patients. Can J Anaesth. 2001; 48(9):919-23.
[3] Kitamura T, Yamada Y, Chinzei M, Du HL, Hanaoka K. Attenuation of haemodynamic responses to tracheal intubation by the styletscope. Br J Anaesth. 2001; 86(2):275-7.
[4] Nishikawa K, Omote K, Kawana S, Namiki A. A comparison of hemodynamic changes after endotracheal intubation by using the lightwand device and the laryngoscope in normotensive and hypertensive patients. Anesth Analg.2000; 90(5):1203-7.
[5] Safavi M, Honarmand A, Azari N. Attenuation of the pressor response to tracheal intubation in severe preeclampsia: Relative efficacies of nitroglycerine infusion, sublingual nifedipine, and intravenous hydralazine. Anesth Pain. 2011; 1(2):81-89.
[6] Rahimzadeh P, Faiz S, Alebouyeh M. Effects of Premedication with metoprolol on bleeding and induced hypotension in nasal surgery. Anesth Pain. 2012; 1(3):157-61.
[7] Salihoglu Z, Demiroluk S, Demirkiran, Kose Y. Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidly obese patients. Eur J Anaesthesiol. 2002; 19(2):125-8.
[8] Abrams JT, Horrow JC, Bennett JA, Van Riper DF, Storella RJ. Upper airway closure: a primary source of difficult ventilation with sufentanil induction of anesthesia. Anesth Analg. 1996; 83(3):629-32.
[9] Choi DH, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Reg Anesth Pain Med. 2000; 25(3):240-5.
[10] Joo HS, Salasidis GC, Kataoka MT, Mazer CD, Naik VN, Chen RB, et al. Comparison of bolus remifentanil versus bolus fentanyl for induction of anesthesia and tracheal intubation in patients with cardiac disease. J Cardiothorac Vasc Anesth. 2004; 18(3):263-8.
[11] 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(3):658-61.
[12] Ugur B, Ogurlu M, Gezer E, Nuri Aydin O, Gursoy F. Effects of esmolol, lidocaine and fentanyl on haemodynamic responses to endotracheal intubation: a comparative study. Clin Drug Investig. 2007; 27(4):269-77.
[13] Kim HT, Kim CK, Lee JH, Kwon YE, Lee JW, Kim DC. Effects of fentanyl and remifentanil on hemodynamic responses to endotracheal intubation during the induction of anesthesia with propofol. Korean J Anesthesiol.2006; 51(5):552-7.
[14] Rio Vellosillo M, Gallego Garcia J, Soliveres Ripoll J, Abengochea Cotaina A, Barbera Alacreu M. Bolus administration of fentanyl vs continuous infusion of remifentanil for control of hemodynamic response to laryngoscopy and orotracheal intubation: a randomized double-blind trial. Rev Esp Anestesiol Reanim.2009; 56(5):287-91.
[15] Imani F, Alebouyeh M, Taghipour-Anvari Z, Faiz S. Use of remifentanil and alfentanil in Endotracheal Intubation: A Comparative Study. Anesth Pain. 2011; 1(2):61-65.
[16] Kim WY, Lee YS, Ok SJ, Chang MS, Kim JH, Park YC. Lidocaine does not prevent bispectral index increase in response to endotracheal intubation. Anesth Analg. 2006; 102(1):156-9.
[17] Aouad MT, Sayyid SS, Zalaket MI, Baraka AS. Intravenous lidocaine as adjuvant to sevoflurane anesthesia for endotracheal intubation in children. Anesth Analg. 2003;96(5):1325-7.
[18] Nishikawa K, Omote K, Kawana S, Namiki A. A comparison of hemodynamic changes after endotracheal intubation by using lightwand device and the laryngoscope in normotensive and hypertensive patients. Anesth analg.2000;90(5):1203-7.
[19] Tripathi D ,Shah KS, Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication. J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):475-80
[20] Ebneshahidi A, Mohseni M. Premedication with oral clonidine decreases intraoperative bleeding and provides hemodynamic stability in cesarean section. Anesth Pain. 2011; 1(1):30-33.
[21] Longnecker DE, Brown DL, Newman MF, Zapol WM. Anesthesiology. McGraw-Hill; 2007
[22] Herroeder S, Pecher S, Schonherr ME, Kaulitz G, Hahnenkamp K, Friess H, et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo controlled trial. Ann Surg.2007; 246(2):192-200.
[23] Langeron O, Birenbaum A, Amour J. Airway management in trauma. Minerva Anestesiol. 2009; 75(5):307-11.
[24] Prys-Roberts C, Greene LT, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth. 1971; 43(6):531-47.
[25] Ali QE, Siddiqui OA, Khan YA. Effects of Xylocard pretreatment on hemodynamics in patients undergoing laparoscopic cholecystectomy. RMJ. 2010; 35(2):188-91.
[26] Shin HY, Kim JW, Kim AR, Jang YH, Kim JM, Bae JI. The Effects of Lidocaine, Fentanyl, Nicardipine, and Esmolol on Hemodynamic and Bispectral Index Responses during Induction with Thiopental Sodium. Korean J Anesthesiol.2007; 53(3):S7-S13.
[27] Levitt MA, Dresden GM. The efficacy of esmolol versus lidocaine to attenuate the hemodynamic response to intubation in isolated head trauma patients. Acad Emerg Med. 2001; 8(1):19-24.
[28] Malde AD, Sarode V. Attenuation of the hemodynamic response to endotracheal intubation: fentanyl versus lignocaine. Internet J Anesthesiol. 2007;12(1)
[29] Feng CK, Chan KH, Liu KN, Or CH, Lee TY. A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996; 34(2):61-7.
[30] Kulka, Peter J, Tryba, Michae Zenz. Dose-response effects of intravenous clonidine on stress response during induction of anesthesia in Coronary Artery Bypass Graft Patients, Anaesthesia & Analgesia . 1995 ; 80 (2) :263-268
[31] Gurulingappa, Md Asif Aleem. Attenuation of Cardiovascular Responses to Direct Laryngoscopy and Intubation-A Comparative Study Between iv Bolus Fentanyl, Lignocaine and Placebo(NS).J Clin Diagn Res. 2012; 6(10): 1749–1752.
[32] Marco P Zalunardo, Andreas Zollinger. Preoperative clonidine attenuates stress response during emergence from anesthesia. Journal of clinical Anesthesia.2000;12(5):343–349
[33] Matot I, Sichel JY, Yofe V, Gozal Y. The effect of clonidine premedication on hemodynamic responses to microlaryngoscopy and rigid bronchoscopy. Anesth Analg 2000;91:828-33.
[34] Sameenakousar, Mahesh, K.V. Srinivasan. Comparison of fentanyl and clonidine for attenuation of the haemodynamic response to laryngocopy and endotracheal intubation. J Clin Diagn Res. 2013; 7(1): 106–111
[35] Valiallah Hassani, Gholamreza Movassaghi , Vahid Goodarzi , Saeid Safari. Comparison of fentanyl and fentanyl plus lidocaine on attenuation of hemodynamic responses to tracheal intubation in controlled hypertensive patients undergoing general anesthesia. Anesth Pain. 2013;2(3):115-118.
Cite This Article
  • APA Style

    Sidharth Sraban Routray, Khagaswar Raut, Debadas Biswal, Kamalakanta Pradhan, Debasis Mishra. (2014). A Comparative Study of Fentanyl –Clonidine and Fentanyl - Lidocaine on Attenuation of Haemodynamic Stress Response to Laryngoscopy and Tracheal Intubation in Hypertensive Patients. International Journal of Anesthesia and Clinical Medicine, 2(4), 27-31. https://doi.org/10.11648/j.ja.20140204.11

    Copy | Download

    ACS Style

    Sidharth Sraban Routray; Khagaswar Raut; Debadas Biswal; Kamalakanta Pradhan; Debasis Mishra. A Comparative Study of Fentanyl –Clonidine and Fentanyl - Lidocaine on Attenuation of Haemodynamic Stress Response to Laryngoscopy and Tracheal Intubation in Hypertensive Patients. Int. J. Anesth. Clin. Med. 2014, 2(4), 27-31. doi: 10.11648/j.ja.20140204.11

    Copy | Download

    AMA Style

    Sidharth Sraban Routray, Khagaswar Raut, Debadas Biswal, Kamalakanta Pradhan, Debasis Mishra. A Comparative Study of Fentanyl –Clonidine and Fentanyl - Lidocaine on Attenuation of Haemodynamic Stress Response to Laryngoscopy and Tracheal Intubation in Hypertensive Patients. Int J Anesth Clin Med. 2014;2(4):27-31. doi: 10.11648/j.ja.20140204.11

    Copy | Download

  • @article{10.11648/j.ja.20140204.11,
      author = {Sidharth Sraban Routray and Khagaswar Raut and Debadas Biswal and Kamalakanta Pradhan and Debasis Mishra},
      title = {A Comparative Study of Fentanyl –Clonidine and Fentanyl - Lidocaine on Attenuation of Haemodynamic Stress Response to Laryngoscopy and Tracheal Intubation in Hypertensive Patients},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {2},
      number = {4},
      pages = {27-31},
      doi = {10.11648/j.ja.20140204.11},
      url = {https://doi.org/10.11648/j.ja.20140204.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ja.20140204.11},
      abstract = {Introduction: Endotracheal intubation may create a period of hemodynamic instability in normotensive patients but more so in hypertensive patients. Endotracheal intubation produces stimulation of laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines leading to hypertensive crisis. Objectives: The objective of study is to evaluate and compare the efficacy of fentanyl- clonidine and fentanyl – lidocaine combine in attenuating the stress responses to laryngoscopy and endotracheal intubation in hypertensive patients. Material and Methods: We conducted a prospective, randomized, double-blind study in 40 patients with controlled hypertension. All patients were randomly divided into two groups, fentanyl-clonidine (FC) group and fentanyl – lidocaine (FL) group. The FC group received Fentanyl 2 mcg/kg and clonidine 2mcg/kg and the FL group received lidocaine1.5mg/kg and fentanyl 2mcg/kg , 3 min prior to intubation. Hemodynamic parameters were recorded at baseline, before giving induction agents, and 1, 3 and 5 minutes after endotracheal intubation. Results: There were no significant differences between the two groups regarding hemodynamic parameters like heart rate, systolic blood pressure, diastolic and mean arterial blood pressure at before induction, 1, 3 and 5 minutes after intubation. Conclusions: Both fentanyl – clonidine and fentanyl – lidocaine combine effectively decreased the stress response to endotracheal intubation.},
     year = {2014}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - A Comparative Study of Fentanyl –Clonidine and Fentanyl - Lidocaine on Attenuation of Haemodynamic Stress Response to Laryngoscopy and Tracheal Intubation in Hypertensive Patients
    AU  - Sidharth Sraban Routray
    AU  - Khagaswar Raut
    AU  - Debadas Biswal
    AU  - Kamalakanta Pradhan
    AU  - Debasis Mishra
    Y1  - 2014/10/30
    PY  - 2014
    N1  - https://doi.org/10.11648/j.ja.20140204.11
    DO  - 10.11648/j.ja.20140204.11
    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 27
    EP  - 31
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/j.ja.20140204.11
    AB  - Introduction: Endotracheal intubation may create a period of hemodynamic instability in normotensive patients but more so in hypertensive patients. Endotracheal intubation produces stimulation of laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines leading to hypertensive crisis. Objectives: The objective of study is to evaluate and compare the efficacy of fentanyl- clonidine and fentanyl – lidocaine combine in attenuating the stress responses to laryngoscopy and endotracheal intubation in hypertensive patients. Material and Methods: We conducted a prospective, randomized, double-blind study in 40 patients with controlled hypertension. All patients were randomly divided into two groups, fentanyl-clonidine (FC) group and fentanyl – lidocaine (FL) group. The FC group received Fentanyl 2 mcg/kg and clonidine 2mcg/kg and the FL group received lidocaine1.5mg/kg and fentanyl 2mcg/kg , 3 min prior to intubation. Hemodynamic parameters were recorded at baseline, before giving induction agents, and 1, 3 and 5 minutes after endotracheal intubation. Results: There were no significant differences between the two groups regarding hemodynamic parameters like heart rate, systolic blood pressure, diastolic and mean arterial blood pressure at before induction, 1, 3 and 5 minutes after intubation. Conclusions: Both fentanyl – clonidine and fentanyl – lidocaine combine effectively decreased the stress response to endotracheal intubation.
    VL  - 2
    IS  - 4
    ER  - 

    Copy | Download

Author Information
  • Department of Anesthesiology and Critical Care, SCB Medical college hospital, Cuttack, Odisha, India

  • Department of Anesthesiology and Critical Care, SCB Medical college hospital, Cuttack, Odisha, India

  • Department of Anesthesiology and Critical Care, SCB Medical college hospital, Cuttack, Odisha, India

  • Department of Anesthesiology and Critical Care, SCB Medical college hospital, Cuttack, Odisha, India

  • Department of Anesthesiology and Critical Care, SCB Medical college hospital, Cuttack, Odisha, India

  • Sections