Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray

Authors

  • Binod Pegu Department of Anaesthesiology, Silchar Medical College, Silchar, Assam, India
  • Suneeta Dutta Department of Anaesthesiology, Silchar Medical College, Silchar, Assam, India
  • Deba Gopal Pathak Department of Anaesthesiology, Silchar Medical College, Silchar, Assam, India
  • Kamal Chandra Deori Department of Anaesthesiology, Silchar Medical College, Silchar, Assam, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20172233

Keywords:

Endotracheal intubation, Fentanyl, Haemodynemic stabi, Nitroglycerine

Abstract

Background: Laryngoscopy and tracheal intubation is invariably associated with certain cardiovascular changes such as tachycardia, rise in blood pressure and a wide variety of cardiac arrhythmias. 1 Such complications are highly detrimental in patients with limited cardiovascular reserve specially in geriatric and elderly population. Various pharmacological agents have been used to attenuate these stress responses but none has yet been considered ideal. Therefore, purpose of this study is to investigate the efficacy of sublingual Nitroglycerine spray alone and sublingual Nitroglycerine spray with intravenous Fentanyl to attenuate the pressor response to laryngoscopy and intubation in normotensive patients.

Methods: A total of 120 ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into 3 groups of 40 in each group. Group 1 control group, Group 2, received NTG sub-lingual spray (0.4mg/spray) two min. before induction, and Group 3 received inj. Fentanyl (2µg/kg) 5min before + NTG sub-lingual spray (0.4 mg/spray) 2min before induction. Vital parameters before and after induction and thereafter at specified time interval following laryngoscopy and intubation were recorded for comparison.

Results: Demographic characteristics and baseline vital parameters in both the groups were comparable. Significant differences in mean arterial pressure (MAP) and heart rate (HR) were observed in between the groups during postintubation period.

Conclusions: Combination of intravenous Fentanyl plus Nitroglycerin spray is more effective than NTG alone in attenuating the stress response following laryngoscopy and intubation.

References

King BD, Harris LC, Breifenstein FE. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology. 1951;12:55-66.

Reid LC, Brace DE. Irritation of the respiratory tract and its reflex effect upon heart. Surg Gynaecol Obstet. 1940;70:157-62S.

Hagberg CA. Artime CA. Airway Management in Adults: Miller’s Anesthesia. Miller RD, Cohen NH, Erikson LI, Fleisher LA, Wiener-Kronish JP, Young WL. 8th Ed.; 2015,1:1647-1680 .

Prys-Roberts C, Greene LT, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth. 1971;43:531-47.

Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1996;8:63-79.

Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressure response to endotracheal intubation. Anaesthesiology. 1977;47:524-5.

Dahlgren N, Messeter K. Treatment of stress response to laryngoscopy and intubation with fentanyl. Anaesthesia. 1981;36:1022-6.

Kumari I, Pathania VS. A prospective randomised double blind placebo controlled trial of oral gabapentin in attenuation of haemodynamic responses during laryngoscopy and tracheal intubation. J Anaesth Clin Pharmacol. 2009;25:439-43.

Kaplan JA, Dunbar RW, Jones EL. Nitroglycerin infusion during coronary-artery surgery. Anesthesiology. 1976;45:14-21.

Ogurlu UB, Erdal MC, Aydin ON. Effects of esmolol, lidocaine and fentanyl on haemodynamic responses to endotracheal intubation: A comparative study. Clin Drug Investig. 2007;27:269-77.

Gupta S, Tank P. A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation. Saudi J Anaesth. 2011 Jan-Mar;5(1):2-8.

Fusciardi J, Godet G, Bernard JM, Bertrand M, Kieffer E, Viars P. Roles of Fentanyl and Nitroglycerin In Prevention Of Myocardial Ischemia Associated With Laryngoscopy And Tracheal Intubation In Patients Undergoing Operations Of Short Duration. Anesth Analg. 1986 Jun;65(6):617-24.

Kumari I, Naithani U, Dadheech VK, Pradeep DS, Meena K, Verma D. Attenuation of pressor response following intubation: Efficacy of nitro-glycerine lingual spray. Journal of Anaesthesiology, Clinical Pharmacology. 2016;32(1):69-73.

Kamra S, Wig J, Sapru RP. Topical Nitroglycerin a Safeguard against Pressor Responses to Tracheal Inlubation. Anaesthesia. 1986;41:1087-91.

Fassoulaki A, Kaniaris P. Intranasal administration of nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea. Br J Anaesth. 1983;55:49-52.

Anant S, Waghray M. Hypertensive response to laryngoscopy and intubation: prevention by intranasal nitroglycerine; Journal of Anaesthesiology Clinical Pharmacology. 1991 Apr;7(2):111-4.

Vyas AB, Chadha IA, Nambiar PM, Bhat VT, Chavada DD, Sorathiya PC. Comparison of different doses of intranasal nitroglycerine in attenuation of pressor response to laryngoscopy and intubation. Anesthesia, Essays and Researches. 2014 Jan;8(1):59-62.

Mikawa K, Hasegawa M, Suzuki T, Maekawa N, Kaetsu H, Goto R, et al. Attenuation of hypertensive response to tracheal intubation with nitroglycerin. J Clin Anesth. 1992;4:367-71.

Grover VK, Sharma S, Mahajan RP, Singh H. Intranasal nitroglycerine attenuates pressor response to tracheal intubation in beta‐blocker treated hypertensive patients. Anaesthesia. 1987 Aug 1;42(8):884-7.

Parida S, Ashraf NC, Mathew JS, Mishra SK, Badhe AS. Attenuation of the haemodynamic responses to tracheal intubation with gabapentin, fentanyl and a combination of both: A randomised controlled trial. Indian J Anaesth. 2015;59:306-11.

Withington PS, Durcan JJ, Weir I, Innis R, Savage T. Haemodynamic and metabolic effects of prophylactic nitroglycerin infusion in the immediate period following coronary artery bypass grafting. European heart journal. 1988 Jan 1;9(suppl A):187-93.

Ebert JP, Pearson JD, Gelman S, Harris C, Bradley EL. Circulatory responses to laryngoscopy: the comparative effects of placebo, fentanyl and esmolol. Canadian Journal of Anaesthesia. 1989 May 1;36(3):301-6.

Mahajan RP, Ramachandran R, Saxena N. Topical nitroglycerin prevents the pressor response to tracheal intubation and sternotomy in patients undergoing coronary artery bypass graft surgery. Anaesthesia. 1993;48:297-300.

Ko SH, Kim DC, Han YJ, Song HS. Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation. Anesthesia and Analgesia. 1998 Mar 1;86(3):658-61.

Downloads

Published

2017-05-23

How to Cite

Pegu, B., Dutta, S., Pathak, D. G., & Deori, K. C. (2017). Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray. International Journal of Basic & Clinical Pharmacology, 6(6), 1414–1419. https://doi.org/10.18203/2319-2003.ijbcp20172233

Issue

Section

Original Research Articles