Intelligent game between intubation and stress regarding hemodynamic and hormonal changes

Abstract

Background Endotracheal intubation is accompanied by a huge amount of stress. Numerous drugs have been used to attenuate such stress Aim of the work To compare the efficacy of Dexmedetomidine and Fentanyl in attenuating the hemodynamic and biochemical stress markers in patients undergoing general anesthesia. Patients and methods This is a prospective randomized controlled study conducted in Assiut University, Faculty of Medicine Hospitals from January 2024 to end of June 2024. Patients meeting the inclusion Criteria were randomly divided into two groups; Group D received Dexmedetomidin and Group F received Fentanyl. All patients underwent ECG monitoring and blood pressure measurement. Four blood samples were drawn from each patient at the following time points: T0 (after 20 minutes resting in supine position), T1 (Two minutes after initiation of anesthesia), T2 (One minute after endotracheal intubation, and T3 (10 minutes after endotracheal intubation). Blood samples were analyzed for Insulin, Blood glucose, T3, T4, Human Growth hormone (HGH), Cortisol, ACTH, Lactic acid and Norepinephrine. Results The study included 100 subjects (80 patients and 20 healthy control subjects with matching age and sex). Patients were randomly divided into two groups Group D (40 patients) and Group F (40 patients). Endotracheal intubation resulted in a significant increase in both hemodynamic and biochemical stress markers in both groups compared to the baseline time of the study (T0) and after the initiation of anesthesia (T1). However, 10 minutes after intubation (T3), there was a slight improvement in both hemodynamic and biochemical markers in both groups. Group D patients showed a significant decline in most of the biochemical parameters studied at T1, T2, and T3 and a significant decline in hemodynamic parameters at T2. However, Group F patients showed earlier recovery after surgery compared to Group D patients. Conclusion Dexmedetomidine proved to be more effective than Fentanyl in decreasing intubation-induced stress. However, Fentanyl resulted in earlier post-operative recovery compared to Dexmedetomidine.