Muhammad, Hasmizy
(2006)
A comparison between fentanyl and esmolol in preventing increase intracranial pressure during endotracheal suction in severe head injury patient.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Preventing increases m intracranial pressure while maintaining adequate cerebral
perfusion is a primary goal in the treatment of adults with a severe head injury. Routine
nursing interventions can trigger reactive intracranial hypertension. For example,
endotracheal suctioning causes a progressive increase in intracranial pressure with each
insertion of the suctioning catheter. In current practice fentanyl, a rapid onset opiod was
given before suctioning to blunt responses to noxious stimuli. Esmolol, a rapid- onset and
short-acting selective betal-adrenergic receptor antagonist is utilized to attenuate the
cardiovascular response to laryngoscopy and as an adjWlct to controlled circulatory
techniques.
Objectives
The goals of this study are to observe the effect of fentanyl and esmolol on the changes in
intracranial pressure, cerebral perfusion pressure, mean arterial pressure and heart rate
responses during endotracheal suctioning in adults with severe head injuries and to
compare the effect of fentanyl and esmolol in preventing increase in intracranial pressure
during endotracheal suction.
Methods
Sixty two patients who are admitted to neurointensive care unit with Glasgow Coma
Scale (GCS) of 8 and less, with intracranial pressure monitoring in place and
mechanically ventilated. The patients were then randomly received either esmolol
(lmglkg) or fentanyl (lmcglkg) before endotracheal suction. Arterial blood pressure
(ABP), mean arterial pressure (MAP)~ heart rate (HR), intracranial pressure (ICP)~
cerebral perfusion pressure (CPP)~ arterial blood gases (ABG) and bispectral index (BIS)
were recorded at baseline, immediately after and 5 minutes, 10 minutes and 15 minutes
after endotracheal suctioning.
Results
There were no significant difference in ICP and BIS in patients who are given either
fentanyl or esmolol in preventing a raise in intracranial pressure during endotracheal
suctioning. A significant difference was seen in mean arterial pressure, cerebral perfusion
pressure and heart rate.
Conclusion
We conclude that in patients with severe head injury who are well sedated and had a
normal intracranial pressure, the used of fentanyl or esmolol in preventing a raise in
intracranial pressure during endotracheal suction has no advantage. However, esmolol (1
mglkg) is better than fentanyl ( 1 meg/kg) in control mean arterial pressure and cerebral
perfusion pressure during endotracheal suctioning.
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