Yip Kin, Soon
(2011)
Serum cortisol measurement in
comparison between dexmedetomidine
and fentanyl for sympathetic
attenuacion during intubation.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Several drugs have been used to attenuate the stressor response to endotracheal
intubation .This study is to compare the sympathetic attenuation response of
dexrnedetornidine versus fentanyl for endotracheal intubation as a sympatholytic by
measuring differences in pre- and post-induction serum cortisol and hemodynamic
parameters This is a prospective, single blinded, randomized clinical trial with 100 patients scheduled
for elective surgery under general anesthesia, ASA class I-II were selected and divided
equally into 2 groups. All patients were given a premedication dose of midazolam and
serum cortisol levels pre-induction of general anesthesia were taken. Pre-induction of
general anesthesia is defmed as the time when the patients arrive at the operation theatre before any induction agents for general anesthesia are given. The test group received a
loading dose of dexmedetomidine 10 meg/kg over 10 minutes, followed by a titrating dose
of propofol and rocuronium 0.6 mg/kg. Post intubation, serum cortisol was resampled. The
control group received a bolus dose of fentanyl 2 meg/kg, propofol 2 mg/kg and IV
rocuronium 0.6 mglkg for intubation, and also had their post-intubation serum cortisol
recorded. The dexmedetomidine group recorded a reduction in serum cortisol levels of 21.61 °/o postinduction
compared to a reduction of only 2.1 °/o for the group receiving fentanyl (p 0.003).
Dexmedetomidine group recorded a mean decrease in serum cortisol post-induction of
103.56 nmoVL, standard deviation 139.61 and the group given fentanyl having a mean
reduction of 9.308 nmol/1, standard deviation 169.52. Hemodynamic parameters showed a
decrease in the fentanyl group compared to the dexmedetomidine, with a decrease in MAP
of 19.07% compared to 12.65% in the dexmedetomidine group (p 0.042). Dexmedetomidine and fentanyl are both safe drugs with sedative, analgesic and
sympatholytic effects. In this study, dexmedetomidine has been shown that it can also
potentially be utilized as an adjunct to laryngoscopy and intubation. Hemodynamic stability
is well maintained with dexmedetomidine, and sympatholysis is possibly superior
compared to fentanyl during intubation.
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