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Background: Intense sympathetic activity is linked to laryngoscopy and endotracheal intubation, which could lead to intraoperative problems. We undertook this study to compare the effects of preoperative nebulized Fentanyl and Dexmedetomidine on hemodynamic response to laryngoscopy and endotracheal intubation, taking advantage of their high bioavailability and better absorption through nasal mucosa. Aim and Objectives: The objectives of the study were (i) to compare the effect of preoperative nebulization on the hemodynamic response to laryngoscopy and intubation; and (ii) to assess intraoperative requirement of anesthetic agents. Materials and Methods: This prospective, randomized, and comparative study was conducted among 100 American Society of Anesthesiologists (ASA) I, II patients (of either gender) undergoing elective surgeries and requiring tracheal intubation, were randomized in two groups. Group A was given Fentanyl Nebulization (2 ?g/kg in 4 ml of 0.9% saline) and Group B was given Dexmedetomidine nebulization (1 ?g/kg in 4 ml of 0.9% saline) 10 min before anesthesia induction. Hemodynamic parameters were noted before and immediately after induction, 1 min, 5 min and 10 min after intubation. The main goal was to assess how Fentanyl and dexmedetomidine nebulization affect the laryngoscopy and intubation-induced stress response. The secondary outcome was to assess the intraoperative requirement of anesthetic agents, observe adverse effects of study drug and sedation score. Results: Dexmedetomidine nebulization was found to be more effective in blunting rise in heart rate post laryngoscopy compared to Fentanyl Nebulization (P < 0.0001) as well as in MAP after 10 min of intubation (P < 0.0001). Requirement of propofol was seen to be significantly reduced in Group B compared to Group A (P < 0.05). Sedation scores were significantly higher in Group B (P < 0.05). No evidence of side effects was observed in any group. Conclusion: Nebulisation of dexmedetomidine was found to be more effective in attenuation of stress response of laryngoscopy and intubation compared to nebulisation of fentanyl, with stable intraoperative hemodynamic and no significant side effects.
RESUMO
Introduction:- Fentanyl which is a short acting, synthetic opioid delivers cardiac stability at therapeutic doses and effectively blocks the sympathetic stress response to surgical stimulus. It also provides further hemodynamic stability. The Bispectral Index (BIS) is a derived electroencephalographic parameter. It has been widely validated as a monitor for depth of anesthesia. Methodology:- 99 patients of either sex, between age Group of 18 – 60 years, ASA Grade I and Grade II, scheduled for surgery under general anesthesia were randomly selected and included in this study. The duration of study was over a period of one year. This study was conducted in the Dept. of Anaesthesiology, Ananta Institute of Medical Sciences and Research Centre. Result:- In this study we were included two groups. 34% male & 66% female were included in Group I. While in Group 2 33% male & 67% female were included. Baseline characteristics of both the groups were not significantly different. There were no significant differences in age & sex& mean duration of surgery between two groups.(p>0.05 ) Conclusion:- This study colludes that, it was inferred that Fentanyl can also help to attenuate laryngoscopic stress response, as the rise in hemodynamics after laryngoscopy and intubation was within the normal limits of heart rate.