Comparison of effects of fentanyl and remifentanil on hemodynamic response to endotracheal intubation and myoclonus in elderly patients with etomidate induction

Abstract

Background: Etomidate has a stable hemodynamic profile after induction, but hypertension and tachycardia are frequent after intubation as well as myoclonus. We compared the effects of fentanyl and remifentanil on the hemodynamic response to intubation and myoclonus during etomidate induction in elderly patients.

Methods: Ninety ASA I or II patients aged over 65 were randomly assigned to 3 groups. Group C received normal saline 10 ml (n = 30), group F and R were pretreated with fentanyl 1.0 µg/kg (n = 30) or remifentanil 1.0 µg/kg with continuous infusion of 0.1 µg/kg/min (n = 30) 1 min before induction with etomidate 0.2 mg/kg. Endotracheal intubation was performed after administration of rocuronium 0.8 mg/kg. Systolic blood pressure (SBP), mean arterial pressure, diastolic blood pressure (DBP), heart rate (HR), and the incidence and intensity of myoclonus were recorded.

Results: After intubation, group R showed significant decreases compared with groups C and F for all of the hemodynamic variables measured. The incidences of increases in SBP and HR of more than 30% of the baseline levels, SBP of > 200 mmHg, and HR of > 120 beats/min were significantly lower in group R (0%, 10%, 0%, and 0%, respectively) compared with groups C (83%, 83%, 30%, and 13%, respectively) and F (63%, 77%, 13%, and 7%, respectively). The frequency and intensity of myoclonus were significantly decreased in both groups F and R compared with group C.

Conclusions: Pretreatment with remifentanil suppressed cardiovascular reactions to endotracheal intubation more effectively than that of fentanyl during etomidate induction. Both opioids reduced the incidence of myoclonus.

Keywords: Endotracheal intubation; Etomidate; Fentanyl; Remifentanil.

Fig. 1

Percent changes of systolic blood pressure (ΔSBP). Values are expressed as mean ± SD. PI: post-induction, BIT: before intubation, IT + 1-5: 1-5 min after intubation, Group C: control group received normal saline, Group F: group received fentanyl 1.0 µg/kg, Group R: group received remifentanil 1.0 µg/kg followed by a continuous infusion of 0.1 µg/kg/min. ^*P < 0.05 compared with control group, ^†P < 0.05 compared with group F.

Fig. 2

Percent changes of mean diastolic blood pressure (ΔDBP). Values are expressed as mean ± SD. PI: post-induction, BIT: before intubation, IT + 1-5: 1-5 min after intubation, Group C: control group received normal saline, Group F: group received fentanyl 1.0 µg/kg, Group R: group received remifentanil 1.0 µg/kg followed by a continuous infusion of 0.1 µg/kg/min. ^*P < 0.05 compared with control group, ^†P < 0.05 compared with group F.

Fig. 3

Percent changes of mean blood pressure (ΔMAP). Values are expressed as mean ± SD. PI: post-induction, BIT: before intubation, IT + 1-5: 1-5 min after intubation, Group C: control group received normal saline, Group F: group received fentanyl 1.0 µg/kg, Group R: group received remifentanil 1.0 µg/kg followed by a continuous infusion of 0.1 µg/kg/min. ^*P < 0.05 compared with control group, ^†P < 0.05 compared with group F.

Fig. 4

Percent changes of heart rate (ΔHR). Values are expressed as mean ± SD. PI: post-induction, BIT: before intubation, IT + 1-5: 1-5 min after intubation, Group C: control group received normal saline, Group F: group received fentanyl 1.0 µg/kg, Group R: group received remifentanil 1.0 µg/kg followed by a continuous infusion of 0.1 µg/kg/min. ^*P < 0.05 compared with control group, ^†P < 0.05 compared with group F.