Title: IV Nalbuphine vs IV Fentanyl in attenuating pressor response: A Comparison
Authors: Dr Chanchal Bhandari, Dr Rashmi Bengali, Dr Tushar Patil
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.98
Abstract
Introduction: Laryngoscopy and tracheal intubation are noxious stimuli that evoke a transient but exaggerated hemodynamic response and increased intracranial pressure. This response may manifest as tachycardia, hypertension, and dysrhythmias with deleterious respiratory, neurological and cardiovascular effects. It is lethal to patients with preexisting coronary artery disease, recent myocardial infection, hypertension, geriatric population, pre-eclampsia and cerebrovascular pathology. Fentanyl is opioid receptor agonist that blocks the stress response to surgical stimuli and it is cardiovascular stable. Nalbuphine is a semi-synthetic opioid analgesic that does not increase systemic blood pressure, pulmonary artery blood pressure, heart rate, or arterial filling pressure. These drugs are compared in attenuating pressor response to laryngoscopy and intubation.
Aims and Objectives
1) To assess the effect of IV Nalbuphine (0.2mg/kg) and IV Fentanyl (2µg/kg) during laryngoscopy and intubation on Pulse rate(PR), Systolic blood pressure(SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP),ECG changes, SPO2 and Respiratory rate(RR)
2) To compare the changes in above factors before intubation, at the time of intubation, after intubation, 1min after intubation, 3mins after intubation, 5mins after intubation, 10 mins after intubation & 15 mins after intubation.
3) To observe and compare for side effects if any
Material and Methods: In a prospective, randomized, comparative study, 60 patients ASA I and II , aged 20-55 years, weight 40-70 kgs undergoing elective surgeries requiring general anaesthesia were included.
Group N – 30 patients were given IV Nalbuphine 0.2 mg/kg diluted in 10ml distilled water.
Group F - 30 patients were given IV Fentanyl 2 µg/kg diluted in 10ml distilled water.
Results: Hemodynamic variations after intubation was more in group F as compared to group N.
Conclusions: From present study it is concluded that both drugs show almost equal rise in heart rate at intubation, but increase in both systolic blood pressure and diastolic blood pressure was more with Fentanyl than Nalbuphine. Hence Nalbuphine can be preferred to control the pressor response to laryngoscopy and intubation with no significant adverse effects.
Keywords: Nalbuphine, Fentanyl, endotracheal intubation, pressor response
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