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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2000 October;66(10):691-6

language: English

Clinical comparison of either small doses of fentanyl or remifentanil for blunting cardiovascular changes induced by tracheal intubation

Albertin A., Casati A., Deni F., Danelli G., Comotti L., Grifoni F., Fanelli G.

From the Department of Anesthesiology (Head: Prof. G. Torri) IRCCS H. San Raffaele University of Milan


Background. To com­pare in a pros­pec­tive, ran­dom­ized ­study the ­effects on car­di­o­vas­cu­lar chang­es ­after tra­cheal intu­ba­tion pro­duced by ­small dos­es of ­either remi­fen­ta­nil or fen­ta­nyl.
Methods. With Ethical Committee approv­al, ­after intra­ve­nous mid­az­o­lam pre­med­i­ca­tion (0.05 mg·kg-1), 30 nor­mo­ten­sive, ASA phys­i­cal stat­us I-II ­patients, with­out car­di­o­vas­cu­lar or res­pir­a­to­ry dis­eas­es, and ­with a Mallampati ­score <2, ­were ran­dom­ly allo­cat­ed to ­receive an intra­ve­nous ­bolus of ­either 3 µg·kg-1 fen­ta­nyl (n=15) or 1 µg·kg-1 remi­fen­ta­nil (n=15) ­infused ­over 60 sec and fol­lowed by a 0.15 µg·kg-1·min-1 con­tin­u­ous intra­ve­nous infu­sion. General anes­the­sia was ­then ­induced ­with pro­pof­ol (2 mg·kg-1), fol­lowed by atra­cu­ri­um besi­late (0.5 mg·kg-1) to facil­i­tate tra­cheal intu­ba­tion. Following intu­ba­tion, the ­lungs ­were ven­ti­lat­ed mechan­i­cal­ly ­using a 60% ­nitrous ­oxide in oxy­gen mix­ture ­with a 1% ­inspired frac­tion of sevof­lu­rane. Arterial ­blood pres­sure and ­heart ­rate ­were record­ed ­before anes­the­sia induc­tion (base­line), one min­ute ­after induc­tion of anes­the­sia, imme­di­ate­ly ­after tra­cheal intu­ba­tion and eve­ry min­ute for the ­first ­five min­utes ­after intu­ba­tion.
Results. Systolic arte­ri­al ­blood pres­sure val­ues ­were sig­nif­i­cant­ly high­er in the Fentanyl ­than in the Remifentanil ­group ­patients ­from 2 to 5 min ­after tra­cheal intu­ba­tion (p<0.01), ­while no dif­fer­enc­es ­were ­observed ­between the two ­groups in ­either dia­stol­ic arte­ri­al ­blood pres­sure or ­heart ­rate val­ues. Four ­patients in the Remifentanil ­group (26%) but ­only one ­patient in the Fentanyl ­group (7%) ­showed sys­tol­ic ­blood pres­sure val­ues <90 mmHg dur­ing the ­study peri­od (p=not sig­nif­i­cant); how­ev­er, the ­observed decreas­es in sys­tol­ic arte­ri­al ­blood pres­sure val­ues ­were tran­sient and did not ­require treat­ment for any sub­ject.
Conclusion. We con­clude ­that in ­healthy nor­mo­ten­sive ­patients, the con­trol of car­di­o­vas­cu­lar respons­es to tra­cheal intu­ba­tion ­obtained ­with a 1 µg·kg-1 load­ing ­dose of remi­fen­ta­nil is ­more effec­tive ­than ­that pro­vid­ed by a 3 µg·kg-1 ­bolus of fen­ta­nyl, ­with the advan­tage of no ­risks for post­op­er­a­tive res­pir­a­to­ry depres­sion.

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