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KMID : 0377519980230040197
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Chung-Ang Journal of Medicine
1998 Volume.23 No. 4 p.197 ~ p.203
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The effects of low-dose fentanyl on hemodynamic responses to endotracheal intubation
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Yoon Jang-Young
Woo Young-Cheol
Jung Yong-Hun
Oh Soo-Won
Koo Gill-Hoi
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Abstract
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Induction of general anesthesia with direct laryngoscopy and tracheal intubation is accompanied by undesirable transient hemodynamic responses such as hypertension, tachycardia and arrhythmia. Many aproaches to attenuate these responses were made and opioid injection is one of effective methods. This study was done to examine blunting effect of low dose fentanyl, which was injected intravenously 5 minutes before tracheal intubation, on the adverse hemodynamic changes following direct larygoscopy and tracheal intubation. Ninety patients, ASA physical status Ⅰ, scheduled for elective surgery, were selected randomly. These were divided into three groups ; control group (n=30), group F2 (fentanyl 2 ㎍/㎏, n=30) and group F5 (fentanyl 5 ㎍/㎏, n=30). Fentanyl were injected 3 minuted before induction with thiopental sodium (3-5 mg/kg) and succinylcholine (1 mg/kg) i.v.. Laryngoscopy and endotracheal intubation were performed 5 minutes after fentanyl injection. After the completion of intubation, 50% nitrous oxide in oxygen and 2.0 vol% enflurane were inhaled. Blood pressure and heart rate were measured before intubation and 1 minute after intubation. After fentanyl injection, frequency of hypoxemia(arterial hemoglobin-oxygen saturation＜90%) and apnea were measured and also dysrhythmia development after intubation were measured. Systolic, diastolic and mean arterial blood pressure were blunted in F2 and F5 group. And diastolic blood pressure showed significant difference between F2 and F5 group. Heart rate was not blunted in F2 group but in F5 group significantly. There was one of apnea and loss of consciousness in F5 group and no arrhythmia in both F2 and F5 groups. Hypoxemia was developed 33% in F2 group and 57% in F5 group. In summary, injection of fentanyl more than 5 ㎍/㎏ is needed to attenuate heart rate increase. And increase of blood pressure in F5 group was more blunted than in F2 group, but it was not significant statistically except diastolic blood pressure.
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KEYWORD
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fentanyl, endotracheal intubation, hemodynamics
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