COMPARATIVE STUDY OF INTRAVENOUS BOLUS DOSES OF NALBUPHINE WITH FENTANYL IN ATTENUATING HEMODYNAMIC RESPONSE TO LARYNGOSCOPY IN PATIENTS UNDERGOING NASAL INTUBATION FOR ORAL AND MAXILLOFACIAL SURGERY UNDER GENERAL ANAESTHESIA
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Keywords
Fentanyl, Hemodynamic pressor response, Nalbuphine, Nasotracheal intubation.
Abstract
BACKGROUND: Nasotracheal intubation is the commonly performed technique in patients undergoing surgeries on head and neck surgeries. Laryngoscopy for guiding the endotracheal tube into trachea induces significant hemodynamic pressor response.
AIM: To compare the efficacy of nalbuphine and fentanyl in attenuation of hemodynamic pressor response in patients undergoing nasal intubation under general anaesthesia for oral and maxillofacial surgeries.
MATERIAL AND METHODS: This prospective, randomized, double blinded study was conducted at Trauma centre, Sir Sunder Lal Hospital, IMS, BHU, Varanasi, India and included 300 ASA I and II patients aged 18-60 years who underwent oral and maxillofacial surgeries. They were randomly divided into two groups of 150 each: Group N (Nalbuphine 0.2mg/kg) and Group F (Fentanyl 2mcg/kg). We assessed hemodynamic changes in two groups during laryngoscopy for nasal intubation. Secondary outcomes were sedation and postoperative pain assessment.
RESULTS: In Group F patients the pressor response was blunted better in comparison to Group N. There was statistically significant difference in postoperative pain (Visual Analogue scale 2) at 2 hours postoperatively (p<0.0001). There was significant difference in Ramsay sedation scale at 0, 1, 2, 3 hours postoperatively (p<0.05).
CONCLUSION: Fentanyl was superior in blunting the pressor response to laryngoscopy and intubation as well as better analgesia but Nalbuphine provided better endotracheal tube tolerance in postoperative period.
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Dr. Shubhangi
Junior Resident, Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Dr. Atul Kumar Singh
Associate Professor, Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Dr. Sanjeev Kumar
Assistant Professor, Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Dr. Amit Kumar Nayak
Associate Professor, Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.