Esmolol Compared with Fentanyl in Attenuating the Hemodynamic Response to Tracheal Intubation in Hypertensive Patients: A Randomized Controlled Study
Issued Date
2022-08-01
Resource Type
ISSN
01252208
Scopus ID
2-s2.0-85136238445
Journal Title
Journal of the Medical Association of Thailand
Volume
105
Issue
8
Start Page
667
End Page
673
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of the Medical Association of Thailand Vol.105 No.8 (2022) , 667-673
Suggested Citation
Watcharotayangul J., Kitpoka Y., Morakul S., Thamjamrassri T. Esmolol Compared with Fentanyl in Attenuating the Hemodynamic Response to Tracheal Intubation in Hypertensive Patients: A Randomized Controlled Study. Journal of the Medical Association of Thailand Vol.105 No.8 (2022) , 667-673. 673. doi:10.35755/jmedassocthai.2022.08.13444 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85653
Title
Esmolol Compared with Fentanyl in Attenuating the Hemodynamic Response to Tracheal Intubation in Hypertensive Patients: A Randomized Controlled Study
Author's Affiliation
Other Contributor(s)
Abstract
Background: Noxious stimuli caused by direct laryngoscopy and endotracheal intubation can produce tachycardia, arrhythmias, and hypertension. These responses are exaggerated in hypertensive patients. Objective: To compare the effect of esmolol and fentanyl in attenuating the cardiovascular response after intubation in hypertensive patients. Materials and Methods: The present study was a parallel randomised controlled trial done in a single center. One hundred hypertensive patients that underwent elective surgery requiring general anesthesia with endotracheal intubation were included. Patients were randomly divided into two groups, the esmolol group with 1.5 mg/kg intravenously and the fentanyl group with 2 μg/kg intravenously. Hemodynamic parameters were recorded at baseline, after study drug administration, at intubation, and 10 minutes thereafter. The primary outcomes were blood pressure and heart rate after intubation. Incidences of hypotension and bradycardia were secondary outcomes. Results: Systolic blood pressure (SBP) after intubation was significantly lower in the fentanyl group than the esmolol group. SBP in the fentanyl group was 15.47 mmHg lower than the esmolol group. Diastolic blood pressure (DBP) in the fentanyl group was 6.96 mmHg lower than the esmolol group. Heart rate after intubation in the fentanyl and esmolol groups was not different. Hypotension was significantly more common in the fentanyl group compared with the esmolol group, while the incidence of bradycardia was not different between the groups. Conclusion: Intravenous fentanyl 2 μg/kg was more effective at attenuating the blood pressure response to intubation in hypertensive patients than intravenous esmolol 1.5 mg/kg. However, fentanyl should be used cautiously due to the frequent occurrence of hypotension.