Key result
Intravenous fentanyl (2 mcg/kg) was superior to lidocaine (1.5 mg/kg) in attenuating the mean rise in heart rate (17.56 vs 29.26 bpm) at the first minute after laryngoscopy and intubation.
Why the study?
Laryngoscopy and endotracheal intubation can trigger pressure and sympathoadrenal responses, requiring comparison of intravenous lidocaine and fentanyl for hemodynamic attenuation during general anesthesia.
Does intravenous fentanyl compared to lidocaine better attenuate the hemodynamic response to laryngoscopy and endotracheal intubation in adults undergoing elective surgery?
RCT (n=52)
randomized
No
Does intravenous fentanyl compared to lidocaine better attenuate the hemodynamic response to laryngoscopy and endotracheal intubation in adults undergoing elective surgery?
Absolute Event Rate: 17.56% vs 29.26%
Intravenous fentanyl 2 µg/kg is superior to lidocaine 1.5 mg/kg in attenuating the hemodynamic response to laryngoscopy and intubation at the first minute, with comparable effects thereafter.
Fentanyl 2 µg/kg may be preferred over lidocaine 1.5 mg/kg to blunt the initial pressor response; extends RCT evidence on short-term attenuation during intubation.
Background: Laryngoscopy and endotracheal intubation is one of the most stressing moments in technique of general anesthesia. It can cause pressure response and sympato adrenal response due to stimulation of epipharynx and laryngopharynx. The main objective of this study is to compare the effect of intravenous lidocaine and fentanyl for attenuation of hemodynamic response during laryngoscopy and intubation in elective patients who undergo general anesthesia with endotracheal intubation. Methods: A randomized controlled trial was conducted in 52 eligible adults allocated in to 2 group; group F (n=26) patients received fentanyl 2 mcg/kg and group L (n=26) patients received lidocaine (2%) 1.5 mg/kg. The hemodynamic variables were recorded at 1st, 3rd, 5th, and 10th minutes after laryngoscopy and intubation. Kolmogorov test were used to test for distributions of data while homogeneity of variance were assessed using Levene test for equality of variance. Between groups comparison of vital sign were made using independent t test symmetric data and Mann-Whitney U test was used for asymmetric data. A post hoc effect size calculated using G-power. Those variables with P-value <0.05 were considered as statistically significant. Result: The mean rise in heart rate from base line was higher in lidocaine group 29.26±15.02 bpm compared with fentanyl group 17.56±10.28 bpm at first minute. The mean rise in systolic blood pressure from base line at first minute is lower in fentanyl group 17.53±13.04 compared with lidocaine group 31.53±17.24. The mean rise in hemodynamic variables (heart rate, systolic blood pressure, means arterial pressure, and diastolic blood pressure) from base line at 3rd, 5th, and 10th were comparable between groups with (P-value >0.05). Conclusion and Recommendation: Fentanyl at 2 µg/kg is superior in attenuation of hemodynamic response to laryngoscopy and intubation at first minute. There is comparable hemodynamic attenuation effect between groups at 3rd, 5th, and 10th minutes after intubation. Based on this we recommended that use of fentanyl 2 µg/kg better blunt hemodynamic response at first minute where both are equal at 3rd, 5th, and 10th minutes.
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Doba et al. (2020) conducted an RCT in Elective surgery requiring general anesthesia and endotracheal intubation (n=52). Intravenous fentanyl vs. Intravenous lidocaine (2%) 1.5 mg/kg was evaluated on Mean rise in heart rate from baseline at first minute (bpm). Intravenous fentanyl (2 mcg/kg) was superior to lidocaine (1.5 mg/kg) in attenuating the mean rise in heart rate (17.56 vs 29.26 bpm) at the first minute after laryngoscopy and intubation.
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