Remifentanil is more effective than lidocaine in attenuating sympathoadrenal response of endotracheal intubation

Authors

  • Sawsan Mohammed Jabbar AL-Hasnawi Kerbala College of medicine

DOI:

https://doi.org/10.70863/karbalajm.v14i1.853

Keywords:

Remifentanil, lidocaine, endotracheal intubation, hemodynamics

Abstract

Background: One of the important tasks of anesthetists is controlling the hemodynamic responses (the increase in blood pressure and heart rate) that are associated with direct laryngoscopy and endotracheal intubation. Many medications were tried for this purpose, among them were remifentanil and lidocaine given intravenously after induction of general anesthesia.

Objectives: The aim of the study is to compare these two medications to determine which gives better results.  

Material and methods: This is a randomized cross-sectional study which was conducted on 60 clinically fit patients, planned for elective surgery under general anesthesia with endotracheal intubation. Patients were divided randomly into two groups Remifentanil and Lidocaine. Baseline readings of systolic, diastolic blood pressure and heart rate were recorded. General anesthesia was induced using intravenous propofol and rocuronium. The study drug was given and the readings again were recorded after 90 seconds followed by direct laryngoscopy and endotracheal intubation. The third and fourth readings were recorded at one & three minutes postintubation respectively.

Results: Mean systolic blood pressure and heart rate were significantly reduced at time 2 & 3, while mean diastolic blood pressure was significantly reduced at time 2 in remifentanil group compared to lidocaine group.

Conclusion: Remifentanil is more effective than lidocaine in attenuating the sympathoadrenal response of direct laryngoscopy and endotracheal intubation.

References

Mowatt C . Preoperative management. In: Lin T, Smith T, Pinnock C, Mowatt C (eds). Fundamentals of Anaesthesia (4th ed). Cambridge University Press: University Printing House; 2016. pp 32.

Baldini G, Butterworth JF, Carli F, Cowles CE, Frölich MA, Giesecke M, et. al. Airway Management. In: Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s Clinical Anesthesiology (5th ed.). McGraw-Hill Education; 2013. pp 310.

Baldini G, Butterworth JF, Carli F, Cowles CE, Frölich MA, Giesecke M, et. al. Anesthesia for Patients with Cardiovascular Disease. In: Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s Clinical Anesthesiology (5th ed.). McGraw-Hill Education; 2013. pp 395.

Derartu ND, Aweke FZ, Simeneh MK, Engida EG, Nugusu A, Sileshi AW, et. al, Comparison of intravenous fentanyl versus lidocaine for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing elective surgery in Dilla University Referral Hospital, Ethiopia, a randomized controlled trial. International Journal of Surgery. 2020 November 3 ; 6: p e27.

Baldini G, Butterworth JF, Carli F, Cowles CE, Frölich MA, Giesecke M, et. al. Anesthesia for Patients with Cardiovascular Disease. In: Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s Clinical Anesthesiology (5th ed.). McGraw-Hill Education; 2013. pp 385.

"Remifentanil, IV opioid analgesic, Remi | Ultiva". www.ultiva.com. Retrieved 2015-11-30.

Guy J, Hindman BJ, Baker KZ, Borel CO, Maktabi M, Ostapkovich N, et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology. 1997 Mar 86; 3:514-524.

Weale NK, Rogers CA, Cooper R, Nolan J, Wolf AR. Effect of remifentanil infusion rate on stress response to the pre-bypass phase of paediatric cardiac surgery. Br J Anaesth. 2004 February 92 ; 2 :187–94.

Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y , Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesthesia and Analgesia. 2014 Mar 118;3: 589–597.

Hoke JF, Cunningham F, James MK, Muir KT, Hoffman WE. Comparative pharmacokinetics and pharmacodynamics of remifentanil, its principle metabolite (GR90291) and alfentanil in dogs. J. Pharmacol. Exp. Ther. 1997 April 281 ;1: 226–32.

The American Society of Health-System Pharmacists. "Lidocaine Hydrochloride (Antiarrhythmic)". Archived from the original on 2015-08-10. Retrieved Aug 26, 2015.

Thippeswamy RR, Shetty SR. Intravenous Low Dose Fentanyl versus Lignocaine in Attenuating the Hemodynamic Responses during Endotracheal Intubation: A Randomized Double-Blind Study. Anesthesia, essays and researches. 2018; 12: 778–785.

Baldini G, Butterworth JF, Carli F, Cowles CE, Frölich MA, Giesecke M, et. al. Intravenous Anesthetics. In: Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s Clinical Anesthesiology (5th ed.). McGraw-Hill Education; 2013. pp 183.

Smith T. Neuromuscular blocking agents. In: Lin T., Smith T., Pinnock C., & Mowatt C.(eds). Fundamentals of Anaesthesia (4th ed). Cambridge University Press: University Printing House; 2016. pp 655.

Kim HJ, Jun JH, Yoo HK, Kim KS, Choi WJ, Cho YH. The Effects of Remifentanil, Lidocaine, Nicardipine and Nitroglycerin on Hemodynamic Changes during Tracheal Intubation. Korean Journal of Anesthesiology. 2008; 54: 614.

Kim JT, Shim JK, Kim SH, Ryu HG, Yoon SZ, Jeon YS, et, al. Remifentanil vs. lignocaine for attenuating the haemodynamic response during rapid sequence induction using propofol: double-blind randomised clinical trial. Anaesth Intensive Care. 2007 Feb 35; 1:20-3.

Nasir FA, Salman JM, Asfar SN. Comparative study of the efficacy of lignocaine and fentanyl after propofol induction in attenuation of hemodynamic changes following laryngoscopy and endotracheal intubation during general anesthesia. Basrah Journal of Surgery. 2019 December 25; 2:13-20.

Published

2021-06-29

How to Cite

AL-Hasnawi, S. M. J. (2021). Remifentanil is more effective than lidocaine in attenuating sympathoadrenal response of endotracheal intubation. Karbala Journal of Medicine, 14(1), 2427–2431. https://doi.org/10.70863/karbalajm.v14i1.853

Issue

Section

Research Articles