Evaluation and Comparison of Fentanyl versus Nalbuphine for Attenuation of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation in General Anesthesia

BACKGROUND: General anesthesia administration involves laryngoscopy and endotracheal intubation which are associated with the pressor response and can lead to tachycardia, hypertension, and arrhythmias, which can be deleterious in compromised patients and hence, this response needs to be suppressed. AIMS: The aim of the study is to compare the effectiveness of intravenous (i.v) fentanyl and nalbuphine on the suppression of hemodynamic response in patients undergoing surgery under general anesthesia. SETTING AND DESIGN: This prospective comparative study was conducted in the department of anesthesiology of a tertiary care center, and patients posted for elective surgery under general anesthesia were included. METHODS: A total of 100 patients of either sex in the age group of 20–50 years, belonging to the American Society of Anesthesiologists physical status classes I and II undergoing surgery under general anesthesia, were divided into two groups: Group N (n = 50) – who received injection nalbuphine 0.2 mg/kg diluted in 10 mL normal saline i.v and Group F (n = 50) – who received injection fentanyl 2 μg/kg diluted in 10 mL of normal saline i.v over 1 min, 5 min prior to intubation. Technique of anesthesia was standardized for all the patients in the study. Heart rate (HR), blood pressure (systolic, diastolic, and mean arterial pressure [SBP, DBP, and MAP]), and oxygen saturation were recorded at baseline, induction, and at 1, 3, 5, and 10 min after intubation. STATISTICAL ANALYSIS: Descriptive statistics were done using mean with standard deviation for quantitative variables, and categorical variables were presented in frequencies along with respective percentages. The statistical comparisons for quantitative variables were done using Student's t-test and for categorical variables, Chi-square was used according to the data. All statistical analyses were performed using SPSS software (Version 22, SPSS Inc., Chicago, IL, USA). All analyses were two tailed, and results were discussed on 5% level of significance, i.e., P < 0.05 was considered statistically significant. RESULTS: The demographic characteristics were comparable in both groups. HR was statistically insignificant between the two groups at all intervals. Comparing SBP, DBP, and MAP between the two groups, there was a significant increase in nalbuphine group than fentanyl group postintubation and was statistically significant at all intervals of time. Maximum rise in SBP, DBP, and MAP was 5.49%, 6.03%, and 5.80% for fentanyl group and 12.88%, 9.37%, and 10.86% for nalbuphine group, respectively. Comparison of oxygen saturation in two groups was statistically insignificant. CONCLUSION: Fentanyl is better than nalbuphine in blunting the pressor response of laryngoscopy and endotracheal intubation.