The addition of fentanyl to thiopentone or midazolam attenuated adverse haemodynamic responses and catecholamine elevations during laryngoscopy and intubation compared to thiopentone alone.
Does the addition of fentanyl to induction agents attenuate the haemodynamic and catecholamine response to laryngoscopy and intubation?
The addition of fentanyl to induction agents like thiopentone or midazolam effectively attenuates the adverse haemodynamic and catecholamine responses during laryngoscopy and intubation without requiring high-dose opioids.
Summary The haemodynamic response and changes in plasma catecholamine concentrations associated with laryngoscopy and tracheal intubation were compared during anaesthesia employing three strictly standardised techniques with commonly used drug combinations. Thirty‐six patients were investigated consecutively resulting in 12 patients in each of three study groups. Anaesthesia was induced with thiopentone 5 mg.kg −1 (group 1), fentanyl 6 ng.kg −1 with thiopentone 5 mg.kg −1 (group 2). or midazolam 0.2 mg.kg −1 with fentanyl 6 ug.kg −1 (group 3). Undesirable changes in haemodynamic effects and an elevation of plasma catecholamine concentrations during laryngoscopy and intubation occurred in group 1. Heart rate and mean arterial pressure increased significantly (34% and 23% respectively). Noradrenaline concentration increased by a maximum of 147%. The addition of fentanyl (groups 2 and 3) attenuated the adverse haemodynamic response and elevation of plasma catecholamine concentrations; heart rate and mean arterial pressure did not differ from pre‐intubation values and plasma catecholamine concentrations decreased steadily. Substitution of thiopentone by midazolam in combination with fentanyl abolished the adverse haemodynamic response and modified the increase in plasma catecholamine concentrations. ‘High‐dose’ opioid anaesthesia is not necessary to produce optimal conditions during laryngoscopy and intubation.
Chraemmer-Jørgensen et al. (1992) studied Anaesthesia for laryngoscopy and tracheal intubation (n=36). Fentanyl combined with thiopentone or midazolam vs. Thiopentone 5 mg.kg-1 alone was evaluated on Haemodynamic response and changes in plasma catecholamine concentrations. The addition of fentanyl to thiopentone or midazolam attenuated adverse haemodynamic responses and catecholamine elevations during laryngoscopy and intubation compared to thiopentone alone.