مقايسه تاثير رمي فنتانيل و فنتانيل بر تغيرات فشار خون و آريتمي در بيماران كانديد جراحي عروقي كرونر در هنگام لوله گذاري تراشه

Comparison between the effectcs of remifentanil and fentanyl on blood pressure and cardiac dysrythmia during tracheal intubation in CABG

Background and purpose: It has been found that the use of different drugs for laryngoscopy preparation and tracheal intubation results in controversy. The aim of this study is to compare the haemodynamic effects of remifentanil with fentanyl for tracheal intubation in patients undergoing coronary artery bypass grafting (CABG). Materials and methods: This is a randomized and double-blind study. We recruited 64 patients undergoing coronary artery bypass surgery. Subjects received in 3 separate groups: remifentanil, 5 microgram/kg, Fentanyl, 8 microgram/kg, and routine medication respectively. Systolic and diastolic blood pressure, heart rate and mean arterial pressure were measured during, before and after tracheal intubation and immediately, 1, 3, 5, 10, minutes after intubation. Patients were monitored for haemodynamic changes using electrocardiography. Results: Sixty four patients were enrolled in the study. Twenty four patients age at 66 ± 5.7 (60-84) years, received remifentanil, 23 patients with mean age of 65.7 ± 6 (60-80) years made up the routin group, and 17 patients with mean age of 65 ± 4.8 (61-76) years received fentanyl. Blood pressure and heart rate decreased after induction of anaesthesia in all groups. SBP and DBP significantly decreased in remifentanil group in comparison with other groups (p= 0.01, 0.03). It was pssoble to control hemodynamic response to tracheal intubation in all groups, although it was better in remifentanil group than other groups. Conclusion: Although the incidence of hypotension was higher, 0.5 microgram/kg of Remifentanil 8 microgram/kg of fentanyl and routine method (sufentanil) were all effective to attenuate patientsʹ blood pressure in response to tracheal intubation up to 3 minutes after intubation.