scholarly journals Comparative Study of Safety and Efficacy of Three Different Doses of Fentanyl on Hemodynamic Response to Laryngoscopy and Tracheal Intubation in Patients under General Anaesthesia

2021 ◽  
pp. 541-551
Author(s):  
Bhavini Shah ◽  
Dipanjali Mahanta ◽  
Ruchir Sakhrani ◽  
Samsuddin Afreen Boat
Keyword(s):  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Hemodynamic Response ◽  
Safety And Efficacy ◽  
Intravenous Fentanyl ◽  
Hemodynamic Variables ◽  
Group B ◽  
Fentanyl Administration ◽  
Different Doses

Aim of Study: Laryngoscopy and endotracheal intubation are the commonest method for securing a definitive airway for general anaesthesia. It is one of the most invasive and painful stimuli in anaesthesia producing clinically relevant changes in the hemodynamic variables. This study has been designed to compare the safety and efficacy of three different doses of fentanyl (2µg/kg, 3µg/kg and 4µg/kg) in attenuating hemodynamic response, following laryngoscopy and endotracheal intubation. Materials and Methods: In this observational study, three groups of 90 patients belonging to ASA grade I and II, aged between 18 to 65 years, including either gender, posted for elective surgery under GA with informed consent. Baseline vital hemodynamic parameters and the serial heart rate, arterial pressures, SpO2 and respiratory rate were noted at five minutes after intravenous fentanyl administration, during laryngoscopy & intubation and at 1-, 3-, 5-, 10- and 20-minutes after laryngoscopy. Ramsay sedation scores were also noted at five minutes after intravenous fentanyl administration, during extubation and at 10-, 20- and 30-minutes after extubation. Results: There was substantial difference in mean HR, SBP, DBP & MAP values post 5 minutes after intravenous fentanyl administration, during laryngoscopy, at 1, 3-, 5-, 10- and 20-minutes following laryngoscopy and intubation between the three groups. Patients’ behaviour belonging to group C (IV fentanyl 4µg/kg), followed by the patients of group B (IV fentanyl 3µg/kg) presented considerable amount of attenuation of all the hemodynamic stress parameters effectively, with statistically significant results when compared to group A (IV fentanyl 2µg/kg). Conclusion: Intravenous fentanyl 4µg/kg and 3µg/kg are better at attenuating the laryngo-tracheal stress response, in comparison to intravenous fentanyl 2µg/kg.

scholarly journals A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

2018 ◽  
Vol 9 (1) ◽  
pp. 65-72
Author(s):  
Erum Ozair ◽  
Qazi Ehsan Ali ◽  
Md Masood Husain Siddiqi ◽  
Syed Hussain Amir ◽  
Shagufta Naaz
Keyword(s):  
Elective Surgery ◽  
Pressor Response ◽  
Demographic Data ◽  
Hemodynamic Response ◽  
T Test ◽  
Chi Square ◽  
Demographic Profiles ◽  
Hemodynamic Variables ◽  
Group A ◽  
Group B

Background: Laryngoscopy and intubation are associated with a sympathetically mediated circulatory response due to irritation of respiratory tract which is associated with increase in pulse rate and blood pressure that may be dangerous.Aims and Objectives: The aim of the present study was to determine and compare the efficacy of dexmedetomidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and intubation and to detect any complication or side effect as a result of these drugs.Materials and Methods: Following approval by ethical committee, 60 ASA grade I and II patients of either sex undergoing general anaesthesia for elective surgery were included in this study. Patients were randomly divided into two groups of 30 patients each. Dexmedetomidine in a dose of 1μg/kg was given to Group A patients and Fentanyl 2 μg/kg was given to Group B patients. Both the drugs were diluted with normal saline solution to make 10ml and were administered slow intravenous 10 min before induction.The hemodynamic parameters were recorded, demographic data was analyzed using unpaired t-test and hemodynamic variables were analyzed by using unpaired and paired t-test. Side effects were analyzed using chi square test.Result: The two groups were comparable in their demographic profiles. Dexmedetomidine proved itself to be an excellent drug when given intravenously as a premedicant in dose of 1μg/kg to attenuate hemodynamic response to laryngoscopy and intubation. It blunted the hemodynamic response to laryngoscopy and intubation to a greater magnitude than fentanylin a dose of 2μg/kg intravenously as a premedicant.Conclusion: We conclude that fentanyl 2μg/kg i.v. given ten minutes prior to airway instrumentation shows an inconsistent response to laryngoscopy and intubation. Between the two drugs under study, the use of dexmedetomidine 1μg/kg i.v. is satisfactory and produces a more favorable hemodynamic profile while fentanyl 2μg/kg is found to be non- dependable and less effective for the attenuation of the pressor response to laryngoscopy and endotracheal intubation. However, further larger studies are required to strengthen these conclusions.Asian Journal of Medical Sciences Vol.9(1) 2018 65-72

scholarly journals ATTENUATION OF HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION WITH INTRAVENOUS DEXMEDETOMIDINE IN PAEDIATRIC AGE GROUP

2020 ◽  
pp. 8-9
Author(s):  
N. Rajanalini ◽  
Selvin Durai. R
Keyword(s):  
Endotracheal Intubation ◽  
Optimal Dose ◽  
Hemodynamic Response ◽  
Age Group ◽  
Significant Difference ◽  
Paediatric Age ◽  
Group A ◽  
Clinically Significant ◽  
Group B ◽  
Different Doses

Laryngoscopic manipulation and endotracheal intubation are noxious stimulus capable of producing tachycardia, arrhythmia, bronchospasm, larygospasm and hypertension.Dexmedetomidine is an Alpha 2 agonist with documented stress attenuation property. Dexmedetomidine has been seldom studied in Paediatric age This study was conducted in a view to find out the optimal dose of Dexmedetomidine for stress attenuation. To attenuate the hemodynamic response to laryngoscopy and endotracheal intubation with 3 different doses of intravenous Dexmedetomidine in Paediatric age group and to find out the optimal dose required for it. Paediatric patientswith sample size 90 undergoing Enucleation & Curettage for Adenotonsillitis, were enrolled for the study. Patients were divided into 3 groups (30 each) receiving: Group A 0.5mcg/kg of Dexmedetomidine. Group B 0.75mcg/kg of Dexmedetomidine. Group C 1mcg/kg of Dexmedetomidine. It was given as 20ml infusion over 10mins.The hemodynamic response was better obtunded in Group B and Group C, when compared with Group A.There was no clinically significant difference between Group B and Group C in any of the parameters at any point of time. So the dose of 0.75mcg/kg of dexmedetomidine is adequate to produce desired stress attenuation with minimal side effects compared to 1mcg/kg. Dexmedetomidine in a dose of 0.75mcg/kg is the optimal dose to attenuate stress response to larygngoscopy and endotracheal intubation with minimal adverse effects.

scholarly journals Attenuation of hemodynamic response to laryngoscopy and endotracheal intubation with two different doses of labetalol in hypertensive patients

2016 ◽  
Vol 32 (3) ◽  
pp. 339-344 ◽  
Author(s):  
Rajender Kumar ◽  
Ritika Gandhi ◽  
Indira Mallick ◽  
Rachna Wadhwa ◽  
Nandita Adlakha ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Hemodynamic Response ◽  
Hypertensive Patients ◽  
Different Doses

Comparison between Sniffing Position and 25 Degree Backup Position in View of Glottis During Direct Laryngoscopy and Intubation - A Study from Mangalore, Karnataka

2021 ◽  
Vol 8 (41) ◽  
pp. 3573-3577
Author(s):  
AKhil Rao U.K. ◽  
Athira Soman ◽  
Anuradha Yadav ◽  
Yashwant R. ◽  
Sucheth Sharat
Keyword(s):  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Randomized Study ◽  
Group I ◽  
Head Positioning ◽  
Difficulty Scale ◽  
Group Ii

BACKGROUND Endotracheal intubation for the purpose of providing anaesthesia was first described by William Mc Ewan. Jackson1 stressed the importance of anterior flexion of the lower cervical spine, in addition to obvious extension of the atlanto-occipital joint. Sniffing position has been commonly advocated as a standard head positioning for direct laryngoscopy which is achieved by flexion of the neck on chest and extension of the head at the atlanto-occipital joint. Present study was designed to evaluate the glottis view and ease of intubation achieved with direct laryngoscopy in the sniffing position with that of 25 degree backup position in a study group of 100 patients divided in 2 groups of 50 each. METHODS This study is a controlled comparative study. Controlled trial in 50 consecutive patients in each group [Group I and Group II] was conducted on patients who underwent elective surgery under general anaesthesia. Inclusion Criteria - General anaesthesia with endotracheal intubation, Aged 18 to 60 years, American society of Anaesthesiologists (ASA) grades I and II. Exclusion Criteria - Patients with body mass index more than 30 kg/m2. 1. Bucked teeth. 2. Restricted neck movement. 3. Inter-incisor gap less than 35 mm. 4. Thyro-mental distance less than 6 mm. 5. Patients with risk of regurgitation and aspiration. 6. Pharyngeal pathology. 7. Limitation of anterior and posterior movement of mandible 8. Pregnant patients Groups wereGroup I – Sniffing position Group II– 25 degree back up position RESULTS The glottis visualization was assessed by Cormack Lehane grading which revealed that glottis view was better in 25 degree backup position than sniffing position. CONCLUSIONS In our prospective randomized study in a series of 50 patients undergoing general anaesthesia in SIMS & RC, intubation difficulty scale (IDS) score was better in 25 degree backup position than sniffing position. It implies glottis view is better in 25 degree backup position than sniffing position. KEYWORDS Sniffing Position, 25 Degree Backup Position, Laryngoscopy

scholarly journals Comparison of Safety and Efficacy of ProSeal Laryngeal Mask Array vs Endotracheal Intubation for Gynecological Diagnostic Laparoscopy

2017 ◽  
Vol 2 (1) ◽  
pp. 9-13
Author(s):  
Shrikanta Oak ◽  
Valmik Avhad
Keyword(s):  
Endotracheal Intubation ◽  
Diagnostic Laparoscopy ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Randomized Study ◽  
Hemodynamic Response ◽  
Laryngeal Mask ◽  
Gastric Distension ◽  
Safety And Efficacy ◽  
Time Required

ABSTRACT This was a prospective randomized study comparing the safety and efficacy of ProSeal laryngeal mask array (PLMA) vs endotracheal intubation (ETT) in gynecological laparoscopic surgeries undertaken in 80 patients with American Society of Anesthesiologist I and II divided into two groups. The parameters assessed were insertion characteristics, hemodynamic response to insertion, gastric distension, and perioperative complications. The demographic data were comparable. The first-time success rate was slightly higher for PLMA than for ETT. The time required for achieving effective airway was longer in ETT than in PLMA (25.6 ± 8.1 seconds for ETT vs 18.2 ± 5 seconds for PLMA). The hemodynamic response to intubation/insertion was more in ETT group than in PLMA group, i.e., there was more rise in pulse rate and mean arterial pressure following ETT than PLMA insertion. Intraoperatively, no episodes of laryngospasm, bronchospasm, desaturation, and inadequate ventilation were observed in both the groups. Postoperatively, sore throat complaints were observed more with ETT than with PLMA. How to cite this article Avhad V, Oak S, Shetty A. Comparison of Safety and Efficacy of ProSeal Laryngeal Mask Array vs Endotracheal Intubation for Gynecological Diagnostic Laparoscopy. Res Inno in Anesth 2017;2(1):9-13.

scholarly journals Evaluation of the True View PCD Video Laryngoscope for Oral Endotracheal Intubation

2020 ◽  
Vol 5 (2) ◽  
pp. 57-61
Author(s):  
Neha Agrawal ◽  
Alks Shah ◽  
Balraj Joshi ◽  
Pinal Vasani
Keyword(s):  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Demographic Data ◽  
Macintosh Laryngoscope ◽  
Video Laryngoscope ◽  
Lehane Grade ◽  
Group 2 ◽  
Difficulty Score ◽  
Group 1

Background: Truview PCD video laryngoscope is particularly planned to assist in locating the endotracheal tube in addition to observe the admission of the tube into the glottis. The present study was performed to assess the outlook of glottic opening and relief of intubation between the Truview PCD laryngoscope and Macintosh laryngoscope in patients undergoes general anaesthesia. Subjects and Methods: Ninety patients of ASA grade 1 and 2 aged 18-60 years, posted for elective surgery under general anaesthesia needing endotracheal intubation were arbitrarily allocated into group 1 (Truview PCD laryngoscope n=45) and group 2 (Macintosh laryngoscope n=45). The two groups were compared for demographic data, intubation difficulty score, Cormack-Lehane grade, time to intubate, number of intubation attempts and hemodynamic parameters. Conclusion: Truview PCD can be measured as an alternate intubation device, especially in difficult intubation conditions.

scholarly journals A comparative study between two different doses of oral pregabalin in attenuating hemodynamic response to laryngoscopy and endotracheal intubation

2020 ◽  
Vol 24 (1) ◽  
pp. 28-35
Author(s):  
Veena Patodi ◽  
Ratan Lal Yadav ◽  
Surendra Kumar Sethi ◽  
Neena Jain ◽  
Maina Singh
Keyword(s):  
Side Effects ◽  
Comparative Study ◽  
Endotracheal Intubation ◽  
Pressor Response ◽  
Randomized Study ◽  
Hemodynamic Response ◽  
Elective Surgical Procedures ◽  
Before And After ◽  
Significant Attenuation ◽  
Different Doses

Background: Laryngoscopy and endotracheal intubation is usually associated with exaggerated haemodynamic response. The aim of our study was to compare and evaluate the efficacy of two different doses of oral pregabalin in attenuating hemodynamic response to laryngoscopy and endotracheal intubation along with preoperative level of sedation. Methodology: This prospective randomized study was conducted on one hundred patients, aged 18 to 55 years of either sex belonging to American Society of Anesthesiologists (ASA) physical status I and II, posted for various elective surgical procedures under general anesthesia. They were randomly allocated into two groups ( Group P1 and Group P2) of 50 patients each by computer generated tables of random numbers. Group P1 and P2 received oral pregabalin 75 mg and 150 mg respectively 1 hour prior to induction of anesthesia. Anesthesia technique was standardized and both groups were assessed for hemodynamic changes (HR,SBP, DBP and MAP ) after premedication, before and after induction, immediately after intubation and at the end of 1, 3, 5, 10 and 15 min after intubation along with preoperative sedation, side effects or complications. Results: The attenuation in mean HR was comparable between two groups, (p > 0.05), with significant attenuation in SBP,DBP and MAP between two groups.(P<0.05). The preoperative levels of sedation were higher in Group P2 but was statistically insignificant. (p > 0.05) None of the patients had experienced any side effects except dizziness. Conclusion: Oral pregabalin 150 mg when used as a premedication 60 min prior to induction of anesthesia was found to be more effective than oral pregabalin 75 mg in terms of significant attenuation of hemodynamic pressor response to laryngoscopy and endotracheal intubation with acceptable levels of sedation and minimal side effects. Citation: Patodi V, Yadav RL, Sethi SK, Jain N, Singh M. A comparative study between two different doses of oral pregabalin in attenuating hemodynamic response to laryngoscopy and endotracheal intubation. Anaesth pain intensive care 2020;24(1):__ Received : 11 September 2019; Reviewed : 16, 26 October 2019, 27 December 2019, February 2020; Revised : 26 November 2019, 31 January, 24 February 2020; Accepted : 29 February 2019

scholarly journals Comparison of laryngeal mask airway supreme™ versus endotracheal intubation in positive pressure ventilation with muscle relaxant for intraoperative and postoperative conditions

2017 ◽  
Vol 6 (1) ◽  
pp. 129 ◽  
Author(s):  
Amol Prakash Singam ◽  
Arpita Ashok Jaiswal ◽  
Ashok Ramkrishna Chaudhari
Keyword(s):  
Postoperative Complications ◽  
Laryngeal Mask Airway ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Hemodynamic Response ◽  
Laryngeal Mask ◽  
Positive Pressure ◽  
Suitable Alternative ◽  
Lma Supreme ◽  
Time Required

Background: Laryngeal Mask Airways are increasingly being used now a day as an option to endotracheal intubation, as it is less invasive and causes less discomfort in the postoperative period. The aim of this study was to evaluate the clinical use of the laryngeal mask airway SupremeTM in patients undergoing elective gynaecological surgeries under general anaesthesia and compare it with endotracheal intubation.Methods: 60 ASA I and II females, having BMI <30kg.m-2 in the range of 20-50 years of age, scheduled for elective gynaecological surgeries were randomly allocated to one of the two groups according to the device used (LMAS or ETT). Time required for insertion, number of attempts, hemodynamic response to insertion/removal and incidence of immediate and late postoperative complications such as coughing, laryngospasm, sore throat, dysphagia etc. were assessed.Results: Number of attempts for successful insertion was similar but time required for LMA Supreme™ insertion was significantly less (25.40±12.90 versus 33.27±14.82 sec) similarly, time required for nasogastric tube insertion was significantly more in ETT group (30.28±16.22 versus 21.93±12.64 sec). No episode of failed ventilation or hypoxia was recorded. The changes in hemodynamic parameters were significantly higher after endotracheal intubation and during extubation. Incidence of postoperative complications was significantly higher after endotracheal intubation (p<0.05).Conclusions: The LMA Supreme™ is a suitable alternative to endotracheal intubation during general anaesthesia for elective gynaecological surgeries with the added advantage of less hemodynamic response during airway management and lower incidence of postoperative complications.

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