Comparative study between Intravenous fentanyl & Intravenous fentanyl with lignocaine for attenuation of haemodynamic responses during laryngoscopy: Our experience from TNMC and BYL Nair ch. Hospital, Mumbai, Maharashtra

Abstract

Introduction: Laryngoscopy, Endotracheal intubation of the trachea stimulates laryngeal and
tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic
amines (adrenaline & noradrenaline). There are various noxious stimuli which can cause
haemodynamic instability during general anaesthesia viz. Laryngoscopy, endotracheal
intubation, skin incision, insertion of trocar, organ manipulation. Both drugs lignocaine &
fentanyl are standard of care & routinely used.Objective: To study the effect of Intravenous
fentanyl & Intravenous fentanyl with lignocaine for attenuation of haemodynamic response
to noxious stimuli viz. laryngoscopy, intubation & skin incision with respect to heart rate,
Systolic blood pressure, Diastolic blood pressure and mean arterial pressure. Methodology:
An open observational comparative study was conducted in ASA-1 patients at department of
anaesthesiology at TNMC and BYL Nair ch. Hospital, Mumbai at tertiary care centre. The
patients were randomly divided into two groups (fentanyl group and fentanyl with lignocaine
group). The fentanyl group received 2mcg/kg and the fentanyl with lignocaine group received
2mcg/kg fentanyl & 1.5mg lignocaine. Hemodynamic variables were recorded. Results: Mean
age was 40.13yrs+/-8.99 in fentanyl group and 45.08+/-9.352 in fentanyl plus lignocaine.There
were 18 males and 22 females in fentanyl group and 15 males and 25 females in fentanyl plus
lignocaine group.The rise in heart rate was seen after intubation and skin incision was more
with fentanyl plus lignocaine group (p<0.01). There was no significant difference between
fentanyl and fentanyl plus lignocaine group after giving drugs. The rise in SBP was seen after
intubation and skin incision was more with fentanyl plus lignocaine group (p<0.01). The rise in
DBP was seen after intubation and skin incision was more with fentanyl plus lignocaine groups (p<0.01).
Conclusion: Thehaemodynamic response was attenuated at various time interval and the
heart rate, blood pressure, post laryngoscopy and post intubation were more attenuated in
fentanyl group than in fentanyl plus lignocaine group and it was proven statistically significant