Effect of remifentanil compared with fentanyl on the haemondynamic response to orotracheal intubation

ABSTRACT

Laryngoscopy and tracheal intubation can cause tachycardia, hypertension, arrhythmias, increased plasma catecholamine concentration and myocardial ischemia in susceptible individuals. To compare the relative efficacy of remifentanil with that of fentanyl in modifying the haemodynamic response to orotracheal intubation. 60 patients ASA physical status I or II were enrolled in the study. Patients were allocated to one of three groups in randomized double - blind manner each consists of 20 patients. Group [1] received glycopyrolate 200 ug IV followed by a bolus dose of remifentanil 0.5 ug kg[-1] over 30 s immediately before induction of anesthesia followed by infusion of remifentanil 0.25 ug kg[-1] min[-1]. Group [2] received glycopyrolate 200 ug IV followed by a bolus dose of fentanyl 2 ug kg[-1] over 30 s followed by infusion of saline. Group [3] received 200 ug glycopyrolate IV followed by a bolus dose of saline over 30 s then infusion, of saline [control group]. SAP decreased with induction of anesthesia and did not increase after intubation in group 1, while it increased significantly after intubation in group 3. DAP decreased after induction and was significantly lower after intubation in group 1. Also the heart rate increased significantly after intubation in group 2 and 3 compared to group 1. we conclude that remifentanil 0.5 ug kg[-1] bolus dose over 30 s before induction of anesthesia followed by infusion of 0.25 ug kg[-1] min[-1] was more effective than a bolus dose of fentanyl 2 up kg[-1] in controlling the haemodynamic response to orotracheal intubation