title: Reflex activity caused by laryngoscopy and intubation is obtunded differently by meptazinol, nalbuphine and fentanyl.
abstract: OBJECTIVE
  To evaluate the different potencies of several opioids in obtunding reflex mechanisms of laryngoscopy and intubation.
  
  
  METHODS
  Three groups of patients (each n = 25, ASA 1-2) undergoing elective plastic surgery were randomly given meptazinol (2.5 mg kg-1), nalbuphine (0.3 mg kg-1) or fentanyl (5 microg kg-1) in a blinded fashion prior to laryngoscopy and intubation. This was followed by a standardized bolus induction of a barbiturate and a muscle relaxant. The response to laryngoscopy and intubation was studied, using blood pressure, heart rate and bispectral index.
  
  
  RESULTS
  With fentanyl, there was an increase of heart rate by 17%, and systolic blood pressure by 7% when compared to control. Bispectral index dropped an additional 8% when compared to 1 min after barbiturate induction. In the nalbuphine group there was a 16% increase in systolic blood pressure, and a 16% increase in heart rate when compared to control. Also, bispectral index increased by 18% when compared to 1 min after barbiturate injection. The group receiving meptazinol demonstrated no cardiovascular changes although bispectral index dropped by an additional 19% when compared to 1 min after barbiturate injection.
  
  
  CONCLUSIONS
  Meptazinol, appears to depress cardiovascular stimulatory effects and electroencephalogram arousal induced by laryngoscopy and intubation better than nalbuphine or fentanyl.
authors.affiliation: Heinrich-Heine-University of Düsseldorf, Clinics of Vascular Surgery and Renal Transplantation, Düsseldorf, Germany. enno.freye@uni-duesseldorf.de
authors.forename: E
authors.initials: E
authors.lastname: Freye
authors.forename: J V
authors.initials: JV
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D003331:Coronary Vessels / Q000187:drug effects; D005283:Fentanyl / Q000494:pharmacology*; D006321:Heart / Q000187:drug effects / Q000502:physiology; D006339:Heart Rate; D006801:Humans; D007440:Intubation; D007828:Laryngoscopy; D008621:Meptazinol / Q000494:pharmacology*; D008875:Middle Aged; D009266:Nalbuphine / Q000494:pharmacology*
chemical_list: D008621:Meptazinol; D009266:Nalbuphine; D005283:Fentanyl