Fentanyl and fentanyl plus lidocaine on attenuation of haemodynamic stress response to laryngoscopy: a comparative study in controlled hypertensive patients posted for laparoscopic cholecystectomy


  • Basant Kumar Department of Anesthesiology and Critical Care, SCB Medical College hospital, Cuttack, Odisha
  • Khagaswar Raut Department of Anesthesiology and Critical Care, SCB Medical College hospital, Cuttack, Odisha
  • Sidharth Sraban Routray Department of Anesthesiology and Critical Care, SCB Medical College hospital, Cuttack, Odisha




Fentanyl, Hemodynamic stress, Intubation, Lidocaine


Background:Endotracheal intubation may create a period of hemodynamic instability in normotensive patients but more so in hypertensive patients. Endotracheal intubation produces stimulation of laryngeal and tracheal sensory receptors, resulting in a marked increase in the elaboration of sympathetic amines leading to hypertensive crisis.

The objective of study is to evaluate and compare the efficacy of fentanyl and fentanyl plus lidocaine in attenuating the stress responses to laryngoscopy and endotracheal intubation in hypertensive patients.

Material and Methods: We conducted a prospective, randomized, double-blind study in 40 patients with controlled   hypertension. All patients were randomly divided into two groups (fentanyl group and fentanyl plus lidocaine group). The fentanyl group received 2 mcg/kg and the fentanyl plus lidocaine group received 1.5mg/kg lidocaine and fentanyl 2mcg/kg, 3 min prior to intubation. Hemodynamic parameters were recorded at baseline, after giving induction agents, and 1, 3 and 5 minutes after endotracheal intubation.

Results: There were no significant differences between the two groups regarding hemodynamic parameters like heart rate, systolic blood pressure and diastolic blood pressure before induction, 3 minutes before intubation and 1, 3 and 5 minutes after intubation.

Conclusions: Both fentanyl and fentanyl plus lidocaine effectively decreased the stress response to endotracheal intubation.



Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987;59(3):295-9.

Nishikawa K, Kawana S, Namiki A. Comparison of the lightwand technique with direct laryngoscopy for awake endotracheal intubation in emergency cases. J Clin Anesth. 2001;13(4):259-63.

Kimura A, Yamakage M, Chen X, Kamada Y, Namiki A. Use of the fibreoptic stylet scope (Styletscope) reduces the hemodynamic response to intubation in normotensive and hypertensive patients. Can J Anaesth. 2001;48(9):919-23.

Kitamura T, Yamada Y, Chinzei M, Du HL, Hanaoka K. Attenuation of haemodynamic responses to tracheal intubation by the styletscope. Br J Anaesth. 2001;86(2):275-7.

Morgan GE, Mikhail MS, Murray MJ, Larson CP. Clinical Anesthesiology. Lange Medical Books/McGraw-Hill; 2002.

Nishikawa K, Omote K, Kawana S, Namiki A. A comparison of hemodynamic changes after endotracheal intubation by using the lightwand device and the laryngoscope in normotensive and hypertensive patients. Anesth Analg. 2000;90(5):1203-7.

Safavi M, Honarmand A, Azari N. Attenuation of the Pressor Response to Tracheal Intubation in Severe Preeclampsia: Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and Intravenous Hydralazine. Anesth Pain. 2011;1(2):81-9.

Rahimzadeh P, Faiz S, Alebouyeh M. Effects of Premedication With Metoprolol on Bleeding and Induced Hypotension in Nasal Surgery. Anesth Pain. 2012;1(3):157-61.

Salihoglu Z, Demiroluk S, Demirkiran, Kose Y. Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidly obese patients. Eur J Anaesthesiol. 2002;19(2):125-8.

Abrams JT, Horrow JC, Bennett JA, Van Riper DF, Storella RJ. Upper airway closure: a primary source of difficult ventilation with sufentanil induction of anesthesia. Anesth Analg. 1996;83(3):629-32.

Choi DH, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Reg Anesth Pain Med. 2000;25(3):240-5.

Joo HS, Salasidis GC, Kataoka MT, Mazer CD, Naik VN, Chen RB. Comparison of bolus remifentanil versus bolus fentanyl for induction of anesthesia and tracheal intubation in patients with cardiac disease. J Cardiothorac Vasc Anesth. 2004;18(3):263-8.

Ko SH, Kim DC, Han YJ, Song HS. Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation. Anesth Analg. 1998;86(3):658-61.

Ugur B, Ogurlu M, Gezer E, Nuri Aydin O, Gursoy F. Effects of esmolol, lidocaine and fentanyl on haemodynamic responses to endotracheal intubation: a comparative study. Clin Drug Investig. 2007;27(4):269-77.

Kim HT, Kim CK, Lee JH, Kwon YE, Lee JW, Kim DC. Effects of fentanyl and remifentanil on hemodynamic responses to endotracheal intubation during the induction of anesthesia with propofol. Korean J Anesthesiol. 2006;51(5):552-7.

Rio Vellosillo M, Gallego Garcia J, Soliveres Ripoll J, Abengochea Cotaina A, Barbera Alacreu M. [Bolus administration of fentanyl vs continuous perfusion of remifentanil for control of hemodynamic response to laryngoscopy and orotracheal intubation: a randomized double-blind trial]. Rev Esp Anestesiol Reanim. 2009;56(5):287-91.

Imani F, Alebouyeh M, Taghipour-Anvari Z, Faiz S. Use of Remifentanil and Alfentanil in Endotracheal Intubation: A Comparative Study. Anesth Pain. 2011;1(2):61-5.

Kim WY, Lee YS, Ok SJ, Chang MS, Kim JH, Park YC. Lidocaine does not prevent bispectral index increases in response to endotracheal intubation. Anesth Analg. 2006;102(1):156-9.

Aouad MT, Sayyid SS, Zalaket MI, Baraka AS. Intravenous lidocaine as adjuvant to sevoflurane anesthesia for endotracheal intubation in children. Anesth Analg. 2003;96(5):1325-7.

Calvey TN, Williams NE. Principles and Practice of Pharmacology for Anaesthetists. Fifth Edition ed. Blackwell Publishing; 2008.

Ebneshahidi A, Mohseni M. Premedication with oral clonidine decreases intraoperative bleeding and provides hemodynamic stability in cesarean section. Anesth Pain. 2011;1(1):30-3.

Longnecker DE, Brown DL, Newman MF, Zapol WM. Anesthesiology. McGraw-Hill; 2007.

Herroeder S, Pecher S, Schonherr ME, Kaulitz G, Hahnenkamp K, Friess H. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebocontrolled trial. Ann Surg. 2007;246(2):192-200.

Langeron O, Birenbaum A, Amour J. Airway management in trauma. Minerva Anestesiol. 2009;75(5):307-11.

Prys-Roberts C, Greene LT, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth. 1971;43(6):531-47.

Ali QE, Siddiqui OA, Khan YA. Effects of Xylocard pretreatment on hemodynamics in patients undergoing laparoscopic cholecystectomy. RMJ. 2010;35(2):188-91.

Shin HY, Kim JW, Kim AR, Jang YH, Kim JM, Bae JI. The Effects of Lidocaine, Fentanyl, Nicardipine, and Esmolol on Hemodynamic and Bispectral Index Responses during Induction with Thiopental Sodium. Korean J Anesthesiol. 2007;53(3):S7-S13.

Levitt MA, Dresden GM. The efficacy of esmolol versus lidocaine to attenuate the hemodynamic response to intubation in isolated head trauma patients. Acad Emerg Med. 2001;8(1):19-24.

Malde AD, Sarode V. Attenuation of the hemodynamic response to endotracheal intubation: fentanyl versus lignocaine. Internet J Anesthesiol. 2007;12(1).

Feng CK, Chan KH, Liu KN, Or CH, Lee TY. A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996;34(2):61-7.




How to Cite

Kumar, B., Raut, K., & Routray, S. S. (2017). Fentanyl and fentanyl plus lidocaine on attenuation of haemodynamic stress response to laryngoscopy: a comparative study in controlled hypertensive patients posted for laparoscopic cholecystectomy. International Journal of Research in Medical Sciences, 3(12), 3687–3690. https://doi.org/10.18203/2320-6012.ijrms20151423



Original Research Articles