Effects of Fentanyl Versus Remifentanil Pretreatment on the QTc Interval in Patients Undergoing Rapid Sequence Intubation: A Randomized Clinical Trial

Abstract

Background: One of the complications of laryngoscopy is cardiac dysrhythmia due to an increased QT interval. Objectives: This study aimed to compare the effect of fentanyl and remifentanil on QTc interval in patients undergoing intubation by the rapid method in 2020. Methods: In this study, 50 patients without a history of heart disease and without a history of drug use who were candidates for rapid intubation in the emergency department were selected and divided into two groups. Before the injection of intubation drugs, a baseline ECG was obtained from the patient and then randomly assigned to one group of patients with 2 μg/kg fentanyl and the other group with 1 μg/kg remifentanil. Other intubation drugs, including lidocaine, etomidate, and succinylcholine, were fixed in both groups. Immediately after drug injection and immediately after laryngoscopy, ECG was prepared from patients, and the QT interval was calculated. Results: In group comparison, changes in QT values during the studied time were statistically significant (P = 0.004). However, in the comparison between groups, there was no statistically significant difference between the two groups receiving fentanyl and remifentanil (P = 0.235). The results showed that the rate of QT interval changes during three different measurements increased in both groups of patients receiving fentanyl and remifentanil. Conclusions: In the present study, in comparing the QT interval, there was a statistically significant difference between the two groups receiving fentanyl and remifentanil at any of the studied times. Therefore, fentanyl and remifentanil during endotracheal intubation did not have a statistically and clinically significant effect on the QT distance of patients' ECG, and the administration of the above two drugs during intubation was safe.