@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2015;20(4):237-242

Background
… [1-4] The utilization of medications such as α₂ agonist receptors seems necessary to inhibit or reduce hemodynamic changes caused by intubation [5]. In addition, drugs have been used long ago to reduce the changes caused by laryngoscopy [6].
Previous Studies
Fentanyl results in hemodynamic and endotracheal responses reductions. Low doses of fentanyl administrated 5min before intubation inhibits hemodynamic responses [7]. … [8, 9] Due to the probability of drug endurance, opium-dependent patients might have no usual response to the drugs, when they need airways through tracheal tube [10]. Clonidine is used as a pre-medication, but its effects on the hemodynamic parameters after intubation for the opium-dependent patients have not yet been studied. … [11]
Aim(s)
The aim of this study was to compare between the effects of clonidine and fentanyl premedication on the hemodynamic factors including heart rate and systolic and diastolic blood pressures in the opium-dependent patients under endotracheal intubation.
Research type
This is a single blind clinical trial study.
Research society, place and time
Patients under selective opium-dependent surgery with general anesthesia and endotracheal intubation (Operation Room, Gonabaad 15 Khordad Hospital; Iran) were studied in 2013.
Sampling method and number
60 patients randomly divided into two equal fentanyl receiving and clonidine receiving groups were studied.
Used devices&materials
Inclusion criteria were age-range between 18 and 65 years, no required urgent surgery, classes 1 and 2 of ASA, more than 6 months consumption of opium or its derivatives, no history of consumption of other drugs such as alcohol and psychedelics, and no anxiety disorders. Exclusion criteria were cardiovascular problems and heart arrhythmia during intubation, unsuccessful first intubation or more than 30 seconds intubation, and any problem during intubation or surgery preventing the interventions and measurements. In fentanyl group, the patient entered in the operation room fully rest on the bed for 10 minutes with no stimulation such as venipuncture. Then, 1μg per Kg of body weight of fentanyl (Abu Raihan; Iran) was injected as intravenous. After 5min, systolic and diastolic blood pressures and the number of heartbeat in the supine position were measured and recorded by a monitoring device (Oxiset: Iran). Equivalent reliability was used for the monitoring device reliability. The patient’s blood pressure and heart rate were measured immediately after anesthesia, laryngoscopy, and intubation and 5min latter again with the same method. In clonidine group, the patients received 4-6μg per Kg of body weight of oral clonidine tablets (TD; Iran) 60min before entering the operation room. As fentanyl group, blood pressure and pulse were measured in the group and at the same times. In both groups, patients with an airway problem and more than 20 seconds laryngoscopy and intubation were excluded. Anesthesia type and the used medications were the same for both groups. Systolic and diastolic blood pressures and heart rate before tracheal intubation, immediately after intubation, and 5min latter were measured. Data was analyzed, using Independent T test (to compare the mean parameters of systolic blood pressure before intervention in both groups), ANOVA (to compare a parameter, e. g. heart rate, at 3 times simultaneously in both groups), and SPSS 16 software.
Findings by Text
59 persons (98.3%) were male. 47 persons (78.3%) were married. 20 persons (33.3%) were illiterate. 30 persons (50%) had diploma. 10 persons (16.7%) were undergraduate or higher. 30 persons (50%), 10 persons (16.7%), and 20 persons (33.3%) were self-employed, state employee, and unemployed, respectively. Mean ages of fentanyl and clonidine groups were 34.40±10.65years and 37.50±11.97years, respectively. Mean weight of fentanyl and clonidine groups were 71.90±12.03Kg and 71.23±10.13Kg, respectively. There was no significant difference between mean heart rate and systolic and diastolic blood pressures before intubation in both groups. Nevertheless, mean heart rate and systolic and diastolic blood pressures immediately after tracheal intubation were higher in both groups than any other time, and there was a significant difference. 5min after intubation, there was a higher heart rate in fentanyl group and a lower heart rate in clonidine group than before intubation. There were significant reductions in systolic and diastolic blood pressures in clonidine group 5min after intubation than before it (Table 1).  
Main comparison to the similar studies
There were significant increases in heart rate and systolic and diastolic blood pressures in both groups immediately after laryngoscopy and intubation. Vascular reflex contraction presents after a few seconds, and following it, sinus tachycardia reaches its maximum during 2min and lasts for 5min [2]. The results are consistent with the present results. There is maximum increase in catecholamine concentration 1min after intubation, and the increase is significant in all groups [12]. The results are consistent with the present results. In fentanyl group, there was maximum increase in systolic blood pressure immediately after intubation, while it decreased to some extent 5min after intubation. Nevertheless, it was higher than the pressure before intubation. 1.5mg/Kg of lidocaine has no effect on hemodynamic changes. Nevertheless, 4μg per Kg of body weight of fentanyl considerably prevent hemodynamic changes [13]. The results are consistent with the present results. Fentanyl administration less inhibited hemodynamic factors than clonidine premedication. Blood pressure changes are due to changes in flex fertile responses [14]. The result is consistent with the present results. Clonidine resulted in a reduction in heartbeat changes after intubation better than fentanyl. In clonidine group, heart rate comes back to the base level 1min after intubation, and it is lower than the base level 5min after intubation, which is significant [15]. The results are consistent with the present results. There was a 9.06% reduction in systolic blood pressure 5min after intubation than its amounts before intubation. Nevertheless, in fentanyl group, there was 1.33% systolic blood pressure higher than the value before intubation. The results are consistent with another study [16]. In fentanyl group, there were higher systolic and diastolic blood pressures to some extent 5min after intubation than the values before that. The results are consistent with other studies [17, 18]. 1min after intubation, the heartbeat returns base level, and 5min after intubation, it is under the base level [15]. The results are consistent with the present results. Immediately after laryngoscopy and intubation, there were 14.23% and 35.28% increase in diastolic blood pressure in clonidine and fentanyl groups, respectively. 5min after intubation, there was 6.67% reduction in clonidine group and 2.05% increase in fentanyl group than before intubation. The results are consistent with other studies [15, 16]. Not only there was no increase in blood pressure in clonidine group than fentanyl group 5min after intubation, but also it hugely reduced. The result is relatively confirmed based on another study [7]. … [19, 20]
Suggestions
More studies at different conditions should be done on both genders.
Limitations
Difficult access to the study samples, no declaration of the true amount of the used drug, and no access to female samples were of the limitation for the present study.
Conclusions
In the opium-dependent patients, the utilization of fentanyl, as a pre-medication and before laryngoscopy and endotracheal intubation, has a weaker effect on controlling the hemodynamic parameters than clonidine.
Acknowledgments
The staff of Gonabaad 15 Khordad Hospital is appreciated.
Conflict of interest
Non-declared
Ethical Permissions
Ethics Committee of Gonabaad University of Medical Sciences confirmed the study.
Funding Sources
The paper is based on an MS thesis approved by Research Council of Gonabaad University of Medical Sciences.

TABLES and CHARTS

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