Comparison of Intravenous Dexmedetomidine and Fentanyl in Attenuating Hemodynamic Responses to Laryngoscopy and Endotracheal Intubation: A Randomized Controlled Study.

Rezumat

Background:

Laryngoscopy and endotracheal intubation trigger abrupt sympathetic stimulation, often resulting in tachycardia and hypertension. These responses may be well tolerated in healthy individuals but pose significant risks in patients with compromised cardiovascular reserve. Pharmacological agents such as dexmedetomidine and fentanyl are widely employed to blunt these pressor responses, though comparative evidence remains essential for clinical decision-making.

 Aim:

To evaluate and compare the efficacy of intravenous dexmedetomidine and fentanyl in attenuating hemodynamic responses during laryngoscopy and intubation.

 Methods:

This prospective, randomized, double-blind study included 60 ASA I–II patients scheduled for elective surgery under general anesthesia. Participants were allocated equally into two groups: Group D received dexmedetomidine infusion, and Group F received fentanyl infusion before laryngoscopy. Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline and at 1, 2, and 3 minutes after intubation. Adverse events were noted. Statistical comparisons were made using appropriate parametric tests, and p < 0.05 was considered significant.

 Results:

Baseline characteristics were comparable across groups. Dexmedetomidine produced a consistent reduction in heart rate and blood pressure following intubation, while fentanyl resulted in noticeable increases across all hemodynamic parameters. At every post-intubation interval, Group D demonstrated significantly lower heart rate, systolic, diastolic, and mean arterial pressures (p < 0.001). Adverse events were minimal; transient bradycardia occurred in two patients receiving dexmedetomidine, whereas hypotension was observed in one patient from each group.

 Conclusion:

Dexmedetomidine is more effective than fentanyl in suppressing the sympathetic surge associated with laryngoscopy and intubation, ensuring greater hemodynamic stability. Both agents were well tolerated, though clinical vigilance remains essential.

 Recommendations:

Dexmedetomidine may be preferred in patients at risk of cardiovascular complications during airway manipulation. Further multicentric trials with larger sample sizes are recommended to reinforce these findings and explore dose-response relationships.