[Bolus administration of fentanyl vs continuous perfusion of remifentanil for control of hemodynamic response to laryngoscopy and orotracheal intubation: a randomized double-blind trial].
OBJECTIVE
To compare the efficacy and safety of fentanyl and remifentanil in the prevention of hemodynamic responses to direct laryngoscopy and orotracheal intubation, and to compare the effects of these techniques on peripheral blood oxyhemoglobin saturation in normotensive women undergoing scheduled gynecologic surgery.


METHODS
Prospective clinical trial in ASA 1-2 patients undergoing gynecologic surgery. The patients were randomized to 2 groups: the remifentanil group received a perfusion of 1 microg x kg(-1) x min(-1) until intubation whereas the fentanyl group received a bolus dose of 2 microg x kg(-1). Etomidate (0.3 mg x kg(-1)) and rocuronium bromide (0.6 mg x kg(-1)) were used for anesthetic induction. Seven serial measurements of systolic, diastolic, and mean arterial pressure were recorded in addition to heart rate and peripheral blood oxyhemoglobin saturation at the following times: baseline, denitrogenation, postinduction, and 3 more times at consecutive 2-minute intervals.


RESULTS
Fifty-four patients were enrolled. A statistically significant attenuation of the postintubation hemodynamic response was observed in the remifentanil group. The effect was evident on arterial pressure (P=.0001) and heart rate (P=.031) with respect to baseline values. That protective effect was not seen in the fentanyl group. No differences in peripheral blood oxyhemoglobin saturation were observed.


CONCLUSIONS
Remifentanil provides greater hemodynamic control than fentanyl at the doses utilized. No adverse effects attributable to these opioids were observed in either group.
del Río Vellosillo
M
M
Servicio de Anestesiología y Reanimación del Pabellón Maternal, Hospital La Fe, Valencia. monicadelriov@hotmail.com
Gallego García
J
J
Soliveres Ripoll
J
J
Abengochea Cotaina
A
A
Barberá Alacreu
M
M
D000328:Adult; D000732:Androstanols / Q000008:administration & dosage; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005045:Etomidate / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000627:therapeutic use; D013509:Gynecologic Surgical Procedures; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy / Q000009:adverse effects*; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010108:Oxyhemoglobins / Q000032:analysis; D010880:Piperidines / Q000008:administration & dosage* / Q000627:therapeutic use; D000077208:Remifentanil; D000077123:Rocuronium
D000732:Androstanols; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D010108:Oxyhemoglobins; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl; D000077123:Rocuronium; D005045:Etomidate