The neurovegetative response to laryngoscopy and intubation has been a critical perioperative concern. Numerous pharmacological agents, such as opioids, local anaesthetics, -blockers and  agonists has been tried to attenuate the haemodynamic challenge and augment analgesia. Dexmedetomidine is an  adrenoceptor, while fentanyl is a μ receptor opioid agonist, both drugs have been clinically tried in various clinical role in anaesthesia practice. They have been claimed to produce sedation, anxiolysis, hypnosis, analgesia, and sympatholysis individually. Dexmedetomidine has been further found to have opioid sparing effect while fentanyl has been used in clinical practice as a sole anaesthetic that blunts the sympathetic response during intubation.  These variable characteristics of two drugsare the point of consideration in the present study to compare their effects on haemodynamic response to laryngoscopy and analgesia.

Keywords: Dexmedetomidine, Fentanyl, Hemodynamic response, Laryngoscopy, Intubation.

1. Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1996 Feb;8(1):63-79. [PubMed PMID: 8695083]
2. Reid LC, Brace DE. Irritation of the respiratory tract and its reflex effect upon heart. SurgGynaecObst 1940; 70: 157-62.
3. Blanc VF, Tremblay NA. The complications of tracheal intubation: a new classification with a review of the literature. Anesth Analg. 1974 Mar-Apr;53(2):202–213. [PubMed PMID:4593090]
4. Shribman A J, Smith G, Achola K.J 1987 “Cardiovascular and catecholamine   responses to laryngoscopy  with and without tracheal intubation”  Br JAnaesth: 59:295-299. [PubMed PMID:3828177]
5. Kayhan Z, Aldemir D, Mutlu H, Öğüş E. Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intuba- tion? Catecholamines, vasopressin or angiotensin?. Eur J Anaesthesiol. 2005 Oct;22(10):780-5. [PubMed PMID: 16211744]
6. Morin AM, Geldner G, Schwarz U, Kahl M, Adams HA, Wulf H, et al. Factors influencing preoperative stress response in coronary artery bypass graft patients. BMC Anesthesiol. 2004 Sep 23;4(1):7. [PubMed PMID: 15387891]
7. Hung O. Understanding hemodynamic responses to tracheal intubation. Journal canadiend'anesthésie. Can J Anaesth. 2001 Sep;48(8):723-6. [PubMed PMID: 11546709] DOI: 10.1007/BF03016684
8. Bailey, P.L. and Stanley, T.H. Intravenous opioid anesthetics. (Chapter 12)in: R.D. Miller (Ed.) Anesthesia. 4th ed. Churchill Livingston, Philadelphia, PA; 1994
9. Kautto UM. Attenuation of the circulatory response to laryngoscopy and intubation by fentanyl. Acta Anaesthesiol Scand. 1982 Jun;26(3):217-21. [PubMed PMID: 7113629]
10. Jaakola ML, Ali-Melkkilä T, Kanto J, et al. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth. 1992;68: 570–575. [PubMed PMID: 1351736]
11. Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000;90: 834–839. [PubMed PMID: 10735784]
12. Suresh KP, Chandrashekara S. Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci. 2012 Jan;5(1):7-13. doi: 10.4103/0974-1208.97779. [PubMed PMID: 22870008]
13. Bruder N, Ortega D, Granthil C. Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation. Ann Fr Anesth Reanim. 1992;11(1):57-71. [PubMed PMID: 1359816]
14. Erum Ozair1, Qazi Ehsan Ali Md Masood Husain Siddiqi et al. A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation. Asian Journal of Medical Sciences . 2018; Vol.9(1) 65-72. https://doi.org/10.3126/ajms.v9i1.18472
15. Takahiko Kamibayashi, Mervyn Maze; Clinical Uses of α2-Adrenergic Agonists. Anesthesiology 2000;93(5):1345-1349.http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1945301
16. Hemmings H Egan T Ebert T. Autonomic Nervous System Pharmacology. Pharmacology and Physiology for Anesthesia. 2013: 218-234. https://doi.org/10.1016/B978-1-4377-1679-5.00013-2
17. Ramsay MA and Luterman DL. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology 2004; 101:787-790. [PubMed PMID: 15329604]
18. Edward Lowenstein, M.D., Phillips Hallowell, M.D., Frederick H. et al. Cardiovascular Response to Large Doses of Intravenous Morphine in Man. The New England Journal of Medicine 1969; 281:1389-1393. DOI: 10.1056/NEJM196912182812503 [PubMed PMID: 5355454].
19. Theodore H. Stanley, MD. Proceedings of the Symposium “Updates of the Clinical Pharmacology of Opioids with Special Attention to Long-Acting Drugs” Fentanyl . Journal of Pain and Symptom Management. 2005;29:S67–S71. [PubMed PMID: 15907648]
20. Abhyuday K, Anita S, Smita P et al. Attenuation of the hemodynamic response to laryngoscopy and tracheal intubation with fentanyl, lignocaine nebulization, and a combination of both: A randomized controlled trial. Anesth Essays Res. 2016; 10(3): 661–666. [PUBMED PMID: 27746569]  doi: 10.4103/0259-1162.191113
21. Yushi U. Adachi, MD*, Maiko Satomoto, MD†, Hideyuki Higuchi, MD, PhD‡, and Kazuhiko Watanabe, MD, PhD§ . Fentanyl Attenuates the Hemodynamic Response to Endotracheal Intubation More Than the Response to Laryngoscopy. ANESTH ANALG 2002;95:233–7 [PUBMED PMID: 12088976].
22. Hoda A, Khan FA. Effect of one minimum alveolar concentration sevoflurane with and without fentanyl on hemodynamic response to laryngoscopy and tracheal intubation. J Anaesthesiol Clin Pharmacol 2011; 27: 522‐6. [PUBMED  PMID: 22096288]. doi: 10.4103/0970-9185.86599

Dr Awadh Bihari Tiwari

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.