Intubation stress responses: Pre-anesthetic dexmedetomidine versus fentanyl in pre-eclamptic patients undergoing caesarean delivery: A prospective double blind randomized study

Background
The cardiovascular response to laryngoscopy and endotracheal intubation occurs due to sympathetic stimulation. This effect is exaggerated in pre-eclamptic patients. The aim of this study is to evaluate the effects of dexmedetomidine given over 10 min and fentanyl 3 min before induction of anesthesia on the blood pressure and heart rate changes during laryngoscopy and tracheal intubation in sever pre-eclamptic patients, and their effect on the neonatal outcome.
Methods
88 sever pre-eclamptic undergoing elective caesarean section under general Anesthesia, were randomly assigned to receive either Dexmedetomidine (0.5 μg kg) over 10 min or fentanyl (1 μg kg) 3 min before induction of anesthesia. Systolic, diastolic and mean arterial pressure and heart rate were recorded just before initiating laryngoscopy and tracheal intubation and at 1 min intervals up to 5 min thereafter. The neonatal outcome was assessed by using Apgar score at 1, 5 and 10 min after delivery and analysis of umbilical artery blood gases.
Results
Mean arterial pressure was significantly decreased after administration of the Dexmedetomidine from (112.89 ± 5.14) to (101.56 ± 3.89) mmHg, after endotracheal intubation (108.14 ± 3.21), the measured hemodynamic variables remained significantly lower than the baseline values (P < 0.05). In fentanyl group, the mean arterial pressure (118.07 ± 4.05) significantly increased after endotracheal intubation as compared to the baseline values (111.75 ± 5.15) (P < 0.05). Apgar score at 1, 5 and 10 min and umbilical artery blood gases analysis after delivery were statistically insignificant between both groups.
Conclusions
Dexmedetomidine given over 10 min before induction of general anesthesia significantly reduced the measured hemodynamic variables compared to baseline values. Dexmedetomidine successfully attenuated the intubation stress response and provided a significant hemodynamic stability more than fentanyl which given 3 min before the induction of anesthesia in sever pre-eclamptic patients. Neither drug was associated with any harmful neonatal outcome.