title: Attenuation of the hemodynamic response to laryngoscopy and tracheal intubation with fentanyl, lignocaine nebulization, and a combination of both: A randomized controlled trial.
abstract: BACKGROUND
  The present study was undertaken to compare and evaluate the efficacy of intravenous (IV) fentanyl and lignocaine airway nebulization and a combination of both in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.
  
  
  METHODS
  Ninety-six patients of either sex aged between 18 and 65 years of age, belonging to the American Society of Anesthesiologists (ASA) health status Classes I and II, undergoing elective surgery requiring general anesthesia with endotracheal intubation were included in the study. Patients were randomly divided into three groups. Group F received IV fentanyl 2 μg/kg, Group L received nebulization with 3 mg/kg of 4% lignocaine, and Group FL received both nebulization with 3 mg/kg of 4% lignocaine and IV fentanyl 2 μg/kg before intubation. Hemodynamic parameters were noted before and immediately after induction, 1 min after intubation, and every minute after intubation for 10 min.
  
  
  RESULTS
  Hemodynamic response to laryngoscopy and intubation was not completely abolished in any of the groups. Nebulized lignocaine was least effective in attenuating hemodynamic response to intubation, and hemodynamic parameters were significantly high after intubation as compared to other groups. Fentanyl alone or in combination with nebulized lignocaine was most effective, and Group F and Group FL were comparable. The maximum increase in mean blood pressure after intubation from baseline in Groups F, L, and FL was 7.4%, 14.6%, and 5.4%, respectively.
  
  
  CONCLUSIONS
  In our study, IV fentanyl 2 μg/kg administered 5 min before induction was found to be the most effective in attenuating the hemodynamic response. There was no advantage to the use of nebulized lignocaine in attenuating the hemodynamic response to laryngoscopy and intubation.
authors.affiliation: Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Abhyuday
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Seth
authors.affiliation: Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India.
authors.forename: Smita
authors.initials: S
authors.lastname: Prakash
authors.affiliation: Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mangilal
authors.initials: M
authors.lastname: Deganwa
authors.affiliation: Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India.
authors.forename: Anoop Raj
authors.initials: AR
authors.lastname: Gogia
keywords: Fentanyl; hemodynamic response; intubation; laryngoscopy; lignocaine; nebulization