The Effect of Fentanyl, Esmolol and Labetalol on Hemodynamic Responses to Endotracheal Intubation

Kim, Dae Chul; Choo, Sung Woo; Chung, Chan Jong

Abstract

This study was done to determine the attenuating effect of fentanyl, esmolol and labetalol on the undesirable hemodynamic response to endotracheal intubation. Eighty patients, ASA physical status I-II, scheduled for elective surgery, were randomly divided to 4 groups(n=20, respectively), received a preintubation dose of either normal saline, 3 ug/kg fentanyl, 3 ug/kg fentanyl and 2.5 mg/kg esmolol, or 3 ug/kg fentanyl and 0.5 mg/kg labetalol. Controlled blood pressure and heart rate were recorded in the operating room at arrival of patients. Denitrogenation was done and 3 ug/kg fentanyl was administered at minute 0. Either sympathetic blocker was intravenously infused for 1 minute at minute 1. Induction was accomplished by administering 5 mg/kg thiopental sodium at minute 3, Larynogscopy and endotracheal intubation were performed by one investigator at minute 5. Data from patients in whom intubation required more than 15 seconds were excluded. Heart rate and blood pressure were recorded every minute for 10 minutes after administration of fentanyl. Highest value of heart rate and systolic blood pressure in all groups were recorded 1 minute after endotracheal intubation. Maximum percent increase in systolic blood pressure(meanSD) after intubation were significantly lower in fentanyl(4%+/-17%), esmolol and fentanyl(-5%+/-14%), and labetalol and fentanyl(-3%+/-20%) groups than in the normal saline(27%+/-15%) group(P<0.05). Maximal percent increase in heart rate was significantly lower only in esmolol and fentanyl(4%+/- 18%)group than in normal saline(27%+/-23%) group(P<0.05). The authors observed that combined pretreatment with esmolol and fentanyl provided more reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.