Efficacy of fentanyl, dexmedetomidine or lidocaine in attenuating the hemodynamic response to rigid bronchoscopy

Mousa, Al Hadad Ali; Abd El-Mabood, Ahmed; Mahmoud, Hamza; Refaie, Bahaa

doi:10.21608/smj.2019.41377

Efficacy of fentanyl, dexmedetomidine or lidocaine in attenuating the hemodynamic response to rigid bronchoscopy

Document Type : Original Article

Authors

Department of Anesthesia, Faculty of Medicine, Sohag University.

10.21608/smj.2019.41377

Abstract

Bronchoscopy entails significant manipulation of the upper and lower respiratory greater hazard to safe anesthesia.There have been many attempts to attenuate these adverse effects. Dexmedetomidine is highly selective, short-acting central alpha 2 agonist. It has increasingly gained popularity among anesthesiologists as adjuvant to general and regional anesthesia techniques. This study was conducted to compare the efficacy of administratingfentanyl, dexmedetomidine or lidocaine on control of hemodynamic changes to rigid bronchoscopy in pediatric patients. Ninety ASA I-II children aged 2-12 year were randomly assigned to 3 groups: fentanyl (F), dexmedetomidine (D) and lidocaine (Z). HR, SAP, MAP, DAP and SPO2 were measured and recorded. Results revealed that patients in the D group showed minimal changes in hemodynamic parameters in response to the procedure of rigid bronchoscopy. We concluded that dexmedetomidine can be used safely and effectively to attenuate the hemodynamic responses to rigid bronchoscopy in pediatric patients.

Main Subjects

Anesthesia.

References

1. Tomori Z, Widdicombe JG. Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol. 1969 Jan;200(1):25–49.

2. Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth. 1970 Jul;42(7):618–24.

3. KING BD, HARRIS LCJ, GREIFENSTEIN FE, ELDER JDJ, DRIPPS RD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology. 1951 Sep;12(5):556–66.

4. Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology. 1977 Dec;47(6):524–5.

5. JENKINS AV. Electrocardiographic findings during bronchoscopy. Anaesthesia [Internet]. 1966 Oct 1;21(4):449–56. Available from: https://doi.org/10.1111/j.1365-2044.1966.tb02649.x

6. Hassan G, Khan G, Yaseen M, Masood T, Qureshi W. Cardiac arrhythmias during fiberoptic bronchoscopy and relation with oxygen saturation. Lung India [Internet]. 2005 Apr 1;22(2):54–9. Available from: http://www.lungindia.com/article.asp?issn=0970-2113

7. Stoelting RK. Attenuation of blood pressure response to laryngoscopy and tracheal intubation with sodium nitroprusside. Anesth Analg. 1979;58(2):116–9.

8. Davies MJ, Cronin KD, Cowie RW. The prevention of hypertension at intubation. A controlled study of intravenous hydrallazine on patients undergoing intracranial surgery. Anaesthesia. 1981 Feb;36(2):147–51.

9. Hosalli V, Es A, Hulkund SY, Joshi C. “Comparative efficacy of different doses of fentanyl on cardiovascular responses to laryngoscopy and tracheal intubation.” J Clin Diagn Res [Internet]. 2014/09/20. 2014 Sep;8(9):GC01-GC3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25386450

10. Boralessa H, Senior DF, Whitwam JG. Cardiovascular response to intubation. A comparative study of thiopentone and midazolam. Anaesthesia. 1983 Jul;38(7):623–7.

11. Hassani V, Movassaghi G, Goodarzi V, Safari S. Comparison of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anesthesia. Anesthesiol Pain Med [Internet]. 2013 Jan 1;2(3):115–8. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821130/

12. Shukry M, Miller JA. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manag. 2010 Apr;6:111–21.

13. Ryu JH, Lee SW, Lee JH, Lee EH, Do SH, Kim CS. Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy. Br J Anaesth. 2012 Mar;108(3):503–11.

14. Lee JS, Park SJ, Min KT. Dexmedetomidine for rigid bronchoscopy in an infant with tracheal web after ventricular septal defect patch repair. Yonsei Med J. 2014;55(2):539–41.

15. Mason KP, Lerman J. Review article: Dexmedetomidine in children: current knowledge and future applications. Anesth Analg. 2011 Nov;113(5):1129–42.

16. STEINHAUS JE, GASKIN L. A study of intravenous lidocaine as a suppressant of cough reflex. Anesthesiology. 1963;24:285–90.

17. POULTON AND ,THOMAS J. MD, JAMES M.D. ,FRANCIS M. III. Cough Suppression by Lidocaine. Anesthesiology [Internet]. 1979 May 1;50(5):470–2. Available from: http://dx.doi.org/

18. Donegan MF, Bedford RF. Intravenously administered lidocaine prevents intracranial hypertension during endotracheal suctioning. Anesthesiology. 1980 Jun;52(6):516–8.

19. Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: intravenous or laryngotracheal? Anesthesiology. 1981 Nov;55(5):578–81.

20. Collinsworth KA, Kalman SM, Harrison DC. The clinical pharmacology of lidocaine as an antiarrhythymic drug. Circulation. 1974 Dec;50(6):1217–30.

21. Pinzoni F, Boniotti C, Molinaro SM, Baraldi A, Berlucchi M. Inhaled foreign bodies in pediatric patients: review of personal experience. Int J Pediatr Otorhinolaryngol. 2007 Dec;71(12):1897–903.

22. Soodan A, Pawar D, Subramanium R. Anesthesia for removal of inhaled foreign bodies in children. Pediatr Anesth [Internet]. 2004 Nov [cited 2019 Jan 19];14(11):947–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15500496

23. Matot I, Sichel JY, Yofe V, Gozal Y. The effect of clonidine premedication on hemodynamic responses to microlaryngoscopy and rigid bronchoscopy. Anesth Analg. 2000;91(4):828–33.

24. Abouzgheib W, Littman J, Pratter M, Bartter T. Efficacy and Safety of Dexmedetomidine During Bronchoscopy in Patients With Moderate to Severe COPD or Emphysema. J Bronchol [Internet]. 2007 Oct [cited 2019 Jan 19];14(4):233–6. Available from: https://insights.ovid.com/crossref?an=00128594-200710000-00004

25. Gandhi S, Radhakrishnan K, Balakrishnan M. Comparison of Dexmedetomidine with Fentanyl in Attenuation of Pressor Response during Laryngoscopy and Intubation. IOSR J Pharm [Internet]. 2014;4(2):2250–3013. Available from: https://pdfs.semanticscholar.org/134b/63ffad9355d57e79fc73749abab2d6a52f48.pdf

26. Gogus N, Akan B, Serger N, Baydar M. The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation. Brazilian J Anesthesiol (English Ed [Internet]. 2014;64(5):314–9. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0104001413002303

27. El Saied MH, Mohamed NN, Mohamed HM, Amin MI. Dexmedetomidine versus fentanyl in anesthesia of cochlear implantation in pediatric patients. Egypt J Anaesth [Internet]. 2016;32(1):55–9. Available from: http://dx.doi.org/10.1016/j.egja.2015.09.016

28. Siddareddigari Velayudha Reddy, Donthu Balaji shaik NA. Dexmedetomidine versus esmolol to attenuate the hemodynamic response to laryngoscopy and tracheal intubation: A randomized double blind clinical study. Int J Appl Basic Med Res. 2014;105–12.

29. Prasad S, Matam U, Ojili G. Comparison of intravenous lignocaine and intravenous dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation. J Dr NTR Univ Heal Sci [Internet]. 2015;4(2):86. Available from: http://www.jdrntruhs.org/text.asp?2015/4/2/86/158579

30. Sreejith Hariharan BM. and PP. Efficacy of intravenous dexmeditomidine versus lidocaine in attenuation of stress response during intubation for laproscopic procedures. Int J Biomed Res. 2016;7(3):99–107.

31. Koptan H, Moustafa A, Atalla H. Comparison of dexmedetomidine, lidocaine, and their combination in attenuation of cardiovascular and catecholamine responses to tracheal extubation and anesthesia emergence in hypertensive patients. Res Opin Anesth Intensive Care [Internet]. 2015;1(1):1. Available from: http://www.roaic.eg.net/text.asp?2015/1/1/1/161307

32. Balata A, Abdel Latif H, Waly S, Mohamed A. Dexmedetomidine Versus Magnesium Sulphate or Lidocaine for Blunting Stress Response To Direct Laryngoscopy and Endotracheal Intubation in Abdominal Surgeries. Zagazig Univ Med J [Internet]. 2018;24(6):492–500. Available from: https://zumj.journals.ekb.eg/article_18288.html

33. Gurulingappa, Aleem MA, Awati MN, Adarsh S. Attenuation of cardiovascular responses to direct laryngoscopy and intubation-A comparative study between iv bolus fentanyl, lignocaine and placebo (NS). J Clin Diagnostic Res. 2012;6(10):1749–52.