Comparison of the Relative Efficacy of Fentanyl Premedication and Repeat-dose Propofol in Attenuating the Cardiovascular Response to Endotracheal Intubation.

Abstract

Background: The cardiovascular response evoked by laryngoscopy and endotracheal intubation while causing no harm to majority of patients, could result in fatal consequences, or morbidity, in patients at risk. Objective: To evaluate the degree of cardiovascular response evoked by laryngoscopy and endotracheal intubation, and compare the effectiveness of repeat-dose propofol and fentanyl premedication in attenuating this cardiovascular response. Methodology: A total of sixty-nine (69) patients participated in this double-blind, randomized, prospective study. The change in the cardiovascular parameters following endotracheal
intubation were evaluated in three groups of patients; Control(Untreated), Repeat-dose propofol and Fentanyl groups. The parameters considered were Heart rate (HR), Systolic arterial pressure (SAP), Diastolic arterial pressure (DAP),Mean arterial pressure (MAP) and Rate-pressure product (RPP). Results: The untreated group had increase in HR (36.4%), SAP (42.3%), DAP (36.5%), MAP (39.3%), RPP (94.2%) following laryngoscopy and intubation. The fentanyl group had minimal increase in HR (11.6%), SAP (11.64%), DAP (11.42%), MAP (11.35%), RPP (24.6%). Similarly the repeat-dose propofol group had minimal increase in HR (13.6%), SAP (16.63%), DAP (19.5%), MAP (17.2%), RPP (32.8%). Conclusion:  Endotracheal intubation in the untreated group was associated with remarkable increases in all the measured cardiovascular parameters whereas patients in the fentanyl group and repeat-dose propofol groups had significantly less increases in the parameters.

Keywords: Laryngoscopy, Intubation, Cardiovascular response.