title: Attenuation of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation with Pre Induction IV Fentanyl Versus Combination of IV Fentanyl and Sub Lingual Nitroglycerin Spray.
abstract: BACKGROUND
  Endotracheal intubation is one of the most invasive stimuli in anesthesia and it's often accompanied by a hemodynamic pressor response. The purpose of this study was to investigate the efficacy of a single pre-induction 2 µg/kg bolus injection of fentanyl followed by two puffs of nitroglycerin sub lingual spray (400 µg /spray) with a thiopentone/suxamethonium sequence in the attenuation of the hemodynamic response to endotracheal intubation in normotensive patients.
  
  
  METHODS
  The study consisted of 80 randomly selected ASA physical status I/II male/female adults who were aged between 18 through 60 years and scheduled for elective surgery. Group I received a single 2 µg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy followed by two puffs of nitroglycerin sub lingual spray (400 µg/spray) 2 minutes prior to intubation (n=40). Group II received a single 2 µg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy (n=40). Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product were compared to basal values at pre-induction, induction, intubation and post-intubation as well as at time increments of 1, 3, 5, 7 and 10 min.
  
  
  RESULTS
  Fentanyl combined with nitroglycerin did not attenuate hemodynamic pressor responses more than fentanyl alone. Increases of HR (7.9%), DBP (4.0%), MAP (3.6%) and RPP (6.0%) along with attenuation of SBP (2.7%) were observed in the fentanyl-nitroglycerin group as compared to the equivalent control measured values.
  
  
  CONCLUSIONS
  A single pre-induction bolus injection of fentanyl followed by two puffs of nitroglycerin sub lingual spray in a thiopentone/suxamethonium anesthetic sequence neither successfully attenuates nor successfully suppresses the hemodynamic pressor response more effectively than fentanyl alone in normotensive patients resulting from endotracheal intubation.
authors.affiliation: Krishna Rajendra Hospital and Cheluvamba Hospital, Mysore Medical College, Rajiv Gandhi University, India.
authors.forename: Vijayalakshmi B
authors.initials: VB
authors.lastname: Channaiah
authors.affiliation: Department of Biological, Chemical and Physical Sciences, Roosevelt University, Chicago, IL 60605, USA.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Kurek
authors.affiliation: Department of Biological, Chemical and Physical Sciences, Roosevelt University, Chicago, IL 60605, USA.
authors.forename: Ryder
authors.initials: R
authors.lastname: Moses
authors.affiliation: College of Nursing and Health Sciences, Barry University, Miami, FL 33161, USA.
authors.forename: Sathees B
authors.initials: SB
authors.lastname: Chandra
mesh_terms: D061605:Administration, Intravenous; D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods*; D013874:Thiopental / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D005996:Nitroglycerin; D013874:Thiopental; D005283:Fentanyl
keywords: attenuation; endotracheal intubation; fentanyl; hemodynamic response; nitroglycerin