Effects of fentanil, alfentanil and remifentanil onto hemodynamic responses to laryngoscopy and endotracheal intubation Laringoskopi ve endotrakeal entübasyona karşi gelişen hemodinamik yanitin önlenmesinde fentanil, alfentanil ve remifentanilin etkinliǧi


Gökçe I. C. , BİLGİN H., Özean B., GURBET A., TÜRKER Y. G.

Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi, vol.34, no.2, pp.111-117, 2006 (Peer-Reviewed Journal) identifier

  • Publication Type: Article / Article
  • Volume: 34 Issue: 2
  • Publication Date: 2006
  • Journal Name: Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi
  • Journal Indexes: Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.111-117
  • Keywords: Alfentanil, Fentanyl, Hemodynamic response, Laryngoscopy, Remifentanil

Abstract

Aim: In this study, we aimed to compare fentanyl, alfentanil and a new opioid agent remifentanil with respect to reflex hemodynamic responses to laryngoscopy and endotracheal intubation in general anesthesia practice. Material and Methods: 90 patients were included in the study and were randomly divided into three equal groups. General anesthesia induced with thiopenthal sodium 5-7 mg kg-1. Patients were received 15 μg kg-1 alfentanil (Group A), 2 μg kg-1 fentanyl (Group F) and 0.5 μg kg-1 remifentanil (Group R) boluses, respectively. Two minutes after vecuronium bromide 0.1 mg kg-1 injection for muscle relaxation, patients were intubated with direct laryngoscopy. Heart rates, systolic and diastolic arterial pressures, mean arterial pressures were recorded before and after induction, and after laryngoscopy and intubation for 6 times. T test used for group comparison, Mann-Whitney U, Wilcoxon Signed Ranks and Kruskal-Wallis tests were used for statistical analyses, p value is <0.05 considered as significant. Results: In our study, systolic and diastolic arterial pressure values after induction were found to be significantly lower compared to the baseline values in all groups (p value range, 0.01-0.001). Arterial pressure values in the fentanyl group following laryngoscopy and intubation were higher than the baseline values compared with the other 2 groups (p<0.05, p<0.01, respectively). In the fentanyl and alfentanil groups, heart rates were lower after induction compared to the baseline values. In the remifentanil group, there was a slight increase in heart rate followed by a decrease after induction. At the time of laryngoscopy, heart rates increased in all groups, but it was found to be more significant in the fentanyl group (p<0.01). After intubation, heart rates decreased under the baseline values in all groups, it was more significant in both fentanyl and alfentanil groups (p<0.01 and p<0.05, respectively). Conclusion: We conclude that, remifentanil, known being strong and short acting with no cumulative effect, the bolus dose of 0.5 μg kg-1 can provide an important advantage suppressing the reflex hemodynamic responses without increasing the incidences of serious side effects.