International Journal of Advances In Case Reports

A COMPARATIVE REVIEW OF ROLE OF LOW DOSES OF MIDAZOLAM AND FENTANYL IN BLUNTING THE HEMODYNAMIC STRESS RESPONSE DURING LARYNGOSCOPY AND INTUBATION

Tina Khurana*

tina.khurana1@gmail.com

Laryngoscopy, Tachycardia, Hypertension, Bronchomotor tone.

Stress during direct laryngoscopy and tracheal intubation and means of ameliorating it has been a topic of constant research and study. The mechanical stimulus of laryngoscopy induces autonomic stimulation leading to tachycardia, hypertension, and alteration in bronchomotor tone. These can be detrimental in patients with critically balanced cardio-respiratory system. An attempt was made to evaluate the effects of pre-treatment with low dose Fentanyl Citrate and Midazolam Hydrochloride in blunting the stress response. Ninety patients requiring orotracheal general anesthesia were studied. Premedication, induction agent and anesthesiologist were constant in all patients. In Group F: Fentanyl 1.5 microgram / kg body weight was given intravenously five minutes before induction of anesthesia. Group M: Midazolam 0.04 mg/kg body weight was given intravenously five minutes before induction of anesthesia. In Group C: control group: None of the above mentioned methods were used to suppress the intubation stress response. Rise in heart rate from operation theatre baseline value during laryngoscopy and intubation was 6.7 % in group F, 16.1% in group M, 17.6% in group C. One minute after, a rise of 11.1%, 22.6%, 24.17% was noted in the three groups respectively (p<0.001). Rise in systolic blood pressure of 3.3%, 7.5 %, 8.2 % was observed during laryngoscopy in the three groups respectively. One minute after, a rise of 6.6 %, 10.8 %, 13.1 % respectively was recorded (p<0.001). Diastolic blood pressure also rose in the same manner. The response to laryngoscopy and intubation was observed more, one minute after wards than during actual laryngoscopy. Fentanyl was more effective than Midazolam in suppressing the stress response.