Comparison of dexmedetomidine and remifentanil for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation

Abstract

Background: This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation.

Methods: A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 µg/kg (Group D, n = 30), remifentanil 1 µg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 µg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 µg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation.

Results: The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05).

Conclusions: In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.

Keywords: Dexmedetomidine; Endotracheal intubation; Hemodynamics; Remifentanil.

Fig. 1

Changes of systolic blood pressure from baseline to 5 min after tracheal intubation. Group D: dexmedetomidine (1 µg/kg), Group R: remifentanil (1 µg/kg), Group C: normal saline, SBP: systolic blood pressure, ^*P < 0.05 compared with Group R, ^†P < 0.05 compared with Group R and C, ^‡P < 0.05 compared with baseline.

Fig. 2

Changes of diastolic blood pressure from baseline to 5 min after tracheal intubation. Group D: dexmedetomidine (1 µg/kg), Group R: remifentanil (1 µg/kg), Group C: normal saline, DBP: diastolic blood pressure, ^*P < 0.05 compared with Group R, ^†P < 0.05 compared with Group D, ^‡P < 0.05 compared with baseline.

Fig. 3

Changes of heart rate from baseline to 5 min after tracheal intubation. Group D: dexmedetomidine (1 µg/kg), Group R: remifentanil (1 µg/kg), Group C: normal saline, HR: heart rate, ^*P < 0.05 compared with Group D, ^†P < 0.05 compared with Group D and Group R, ^‡P < 0.05 compared with baseline.