A COMPARATIVE STUDY OF FENTANYL WITH MIDAZOLAM VERSUS DEXMEDETOMIDINE FOR THE ATTENUATION OF HEMODYNAMIC RESPONSE DURING LARYNGOSCOPY AND INTUBATION

Dr. M. Sri Harsha; Dr. Padma Vishal

Volume : VI, Issue : III, March - 2016

A COMPARATIVE STUDY OF FENTANYL WITH MIDAZOLAM VERSUS DEXMEDETOMIDINE FOR THE ATTENUATION OF HEMODYNAMIC RESPONSE DURING LARYNGOSCOPY AND INTUBATION

Dr. M. Sri Harsha, Dr. Padma Vishal

Abstract :

Endotracheal intubation and laryngoscopy are very essential tools in the hands of anaesthesiologists in maintaining airway. The circulatory response to laryngeal and tracheal stimulation following laryngoscopy and tracheal intubation is reflex sympathoadrenal stimulation. Although increase in heart rate and blood pressure due to sympathoadrenal response are short lived, they may have detrimental effects in high risk patients especially those with cardiovascular diseases, increased intracranial pressure or anomalies of cereal vessels. Laryngoscopy and tracheal intubation induced pressor responses have been associated with increase in catecholamine levels. Norepinephrine, epinephrine levels rise. Rise of these catecholamines are associated with elevation of blood pressure and heart rate. Many strategies have been advocated to minimize the haemodynamic adverse responses and aimed at different levels of the reflex arc. Among the recommended procedures IV Lignocaine, Fentanyl, Esmolol, Midazolam and Dexmedetomidine appear to fulfill the above mentioned criteria. Intravenous lignocaine has shown variable results. Large doses of Fentanyl may cause unwanted side effects. Dexmedetomidine has been consistently associated with control of pressor response to laryngoscopy and intubation.