Comparing the Effects of Dexmedetomidine and Fentanyl on Hemodynamic Response to Tracheal Intubation in Lumbar Spine Surgery: A Randomized Double Blind Clinical Trial

Dexmedetomidine is a new sedative that has analgesic and sympatholytic effects. This study was performed to compare the hemodynamic response of dexmedetomidine and fentanyl after endotracheal intubation in lumbar spine surgery.

In a double-blind clinical trial, 80 patients aged 20-65 years candidates for elective spinal surgery were randomly divided into two groups to receive either dexmedetomidine or fentanyl. In case group, dexmedetomidine (0.5 mcg/kg) and in control group fentanyl (1 mcg/kg in 50 ml of normal saline) were administered 10 minutes before endotracheal intubation. Heart rate and mean arterial pressure were measured at 1, 3, 5, and 10 minutes after intubation. Endotracheal intubation quality and first time of postoperative pain were also measured using Copenhagen score and numerical rating scale, respectively.

Heart rates at 1, 3, 5, and 10 minutes after intubation were 77.60±8.29, 75.73±8.12, 76.44±9.62, and 76.43±7.87 in dexmedetomidine group and 82.7±11.31, 82.08±10.91, 79.93±10.0, and 74.28±14.04 in fentanyl group, respectively (P˂0.001). Mean arterial pressure at 1, 3, 5, and 10 minutes after intubation were 87.45±18.68, 82.25±13.78, 81.78±13.77, and 79.13±14.81 in dexmedetomidine group and 94.95±19.40, 92.23±17.51, 88.28±15.20, and 83.18±13.43 in fentanyl group, respectively (P˂0.001). Quality of intubation was not found to be significantly different between the two groups (P= 0.10). The mean of first time postoperative pain was 9.34±7.11 minutes in fentanyl group and 13.66±10.21 minutes in dexmedomidine group (P= 0.03).

This study showed that hemodynamic changes after endotracheal intubation were less in patients who received dxmedetomidine compared to those that received fentanyl.