Comparison of high dose fentanyl, magnesium and lidocaine for effective and consistent attenuation of hemodynamic responses during laryngoscopy and intubation

Abstract

Background & objective: Laryngoscopy and endotracheal intubation provoke stress response with consequent hemodynamic instability. Fentanyl is a short acting potent opioid commonly used to control stress response. Magnesium sulphate can attenuate stress response through inhibiting catecholamines release. Systemic administration of lidocaine helps in blocking stress response. This study aimed to compare the effectiveness of high dose fentanyl, magnesium, and lidocaine versus conventional anesthesia on consistent attenuation of stress response to laryngoscopy and endotracheal intubation.

Methods: 160 patients were randomly allocated into one of the 4 study groups. Group C: received fentanyl 2µg/kg, Group F: received fentanyl 4 µg/kg, Group M: received magnesium sulphate 30mg/kg combined with fentanyl 2µg/kg and Group L: received lidocaine 1.5 mg/kg combined with fentanyl 2 µg/kg. Outcome measures included heart rate (HR) values and mean arterial blood pressure (MAP) values during endotracheal intubation and over the following 5 min in addition to coughing and lacrimation during intubation.

Results: HR in group C and group L increased compared to baseline readings following intubation and at 1,3,5 min and was statistically significant for group C but comparable for group L. In group F and group M, HR decreased significantly compared to baseline following intubation and the rest of the times studied. MAP in group C and L were maintained for the period of 5 min following intubation whereas group F and L showed a statistically significant reduction in their MAP values compared to baseline readings.

Conclusion: High dose fentanyl, fentanyl-magnesium combination, and fentanyl- lidocaine combination can attenuate stress response to laryngoscopy and endotracheal intubation when compared to conventional anesthesia. Furthermore, using high dose fentanyl and fentanyl-Magnesium combination results in consistent attenuation of the response.

Abbreviations: HR – heart rate; MAP – mean arterial blood pressure; PPV - positive pressure ventilation

Key words: Fentanyl; Magnesium sulphate; Lidocaine; Hemodynamics; Intubation

Trial registration: This trial was prospectively registered at Clinical Trials.gov on 3 September 2020 with registration number NCT04544163. https://clinicaltrials.gov/ct2/show/NCT04544163

Citation: Elsabeeny WY, Shehab NN. The role of high dose fentanyl, magnesium and lidocaine for effective and consistent attenuation of hemodynamic responses during laryngoscopy and intubation. Anaesth. pain intensive care 2022;26(3):352-359. DOI: 10.35975/apic.v26i3.1910

Received: July 05, 2021; Reviewed: March 03, 2022; Accepted: April 22, 2022