BACKGROUND: Laryngoscopy and endotracheal intubation cause hemodynamic changes such as hypertension and tachycardia. Adjuvant fentanyl administration have been used to reduce the hemodynamic changes. Remifentanil, a newly developed ultra short acting opioid, has recently been used to reduce the hemodynamic changes. This study investigated the effects of fentanyl and remifentanil on hemodynamic responses to laryngoscopy and endotracheal intubation.

METHODS: Sixth ASA class I or II patients who scheduled for elective surgery were divided randomly into 3 groups. Each patient received normal saline, fentanyl 1.5µg/kg or remifentanil 1.5µg/kg, respectively. Predetermined drugs for each group were administered over 30 seconds after induction of anesthesia with TCI of propofol effect site target concentration 4.0µg/ml and rocuronium 1.0 mg/kg. Laryngoscopy and endotracheal intubation was carried out and systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured baseline (initial), before intubation (BI) and during 5 minutes after intubation (I1 to I5).

RESULTS: In the fentanyl group, I1 HR value was significantly higher than baseline. In the remifentanil group, SBP and MAP were significantly lower than baseline during post-intubation period. Fentanyl and remifentanil groups show lesser hemodynamic changes than those in the control group. There were no significant differences of hemodynamic changes between fentanyl and remifentanil group.

CONCLUSIONS: Fentanyl and remifentanil can attenuate hemodynamic responses after laryngoscopy and endotracheal intubation.