Neha Mehra

Abstract

Background: Increased sympathoadrenal activity invariably occurs during endotracheal intubation. Various drugs have been used to obtund this pressor response. This study was done to find out most favourable drug among fentanyl, nalbuphine and clonidine for prevention of this pressor response. Materials and Methods: This was a randomized, prospective study involving ninety patients of ASA grade 1, equally divided into three groups. Group F, C and N received fentanyl 2 mcg /kg, Clonidine 2 mcg/kg and nalbuphine 2mg/kg i.v respectively, 5 minutes prior to induction. Vitals parameters were noted at frequent intervals Chi square test and Anova test were used for statistical analysis. P value statistically significant. Results: Maximum increase in heart rate and blood pressure was seen at the time of intubation in F and N groups, whereas decrease in these parameters occured with clonIdine, difference was found to be stastistically significant. Haemodynamic stability was seen in F and N group after 5 minutes of intubation. Clonidine showed maximum decrease in heart rate and systolic as well as diastolic blood pressure at all time intervals from intubation as compared to other two groups. Conclusion: In this study it was found that Clonidine produced an earlier and more stable haemodynamics as compared to Fentanyl and Nalbuphine, and it can be concluded that Clonidine given intravenously in doses of 2 mcg/kg 5 minutes prior to intubation is superior to Fentanyl and Nalbuphine in preventing heamodynamic changes at the time of laryngoscopy and intubation. Keywords: Fentanyl, Clonidine, Nalbuphine, Pressor response.

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Abstract

Background and Aims: Etomidate is used for induction of anaesthesia in haemodynamically unstable patients but its use is associated with undesirable side effects like myoclonus, incidence of which is 50- 80%. This prospective, randomized, placebo controlled study is to compare the effect of dexamethasone and fentanyl for prevention of etomidate induced myoclonus. Materials and Methods: Ninety adult patients were randomly assigned into three groups to receive Dexamethasone (group D), Fentanyl (group F) and placebo (group P) five min before injection etomidate 0.3mg/kg IV. The patients were assessed for myoclonus using a four point intensity scoring system over a period of 5 min. ANOVA and chi square test were used for statistical analysis and P as statistically significant. Results: The incidence of myoclonus was significantly reduced in groups D and F compared with group P (p value 0.001).The incidence of pain associated with Etomidate induced myoclonus also was significantly reduced in groups D and F compared to group P (p value 0.001). Conclusion: Dexamethasone significantly reduces the incidence of myoclonus as compared to placebo. It also significantly reduces the pain associated with Etomidate injection. However its efficacy to reduce pain and myoclonus as compared to Fentanyl is much less. Keywords: Etomidate, Myoclonus, Dexamethasone.

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