Dr Sk Ahadul Islam, Dr Sujata Dalai


Objective: The haemodynamic changes associated with laryngoscopy and endotracheal intubation are due to mainly sympathoadrenal reflex and release of norepinephrine, epinephrine.  So, laryngoscopy and intubation is a challenge to anaesthesiologist with obtundation of pressor response in these patients.

Methods: Seventy patients were randomly selected matching the inclusion criteria and they were randomly allocated in either of two groups (n=35).  Group F was given i.v. fentanyl 2mcg/kg and group N given i.v. Nalbuphine 0.2 mg/kg five min before intubation.  we excluded the patient whose laryngoscope and intubation time was exceeded 15 secs.

Results:  The  SBP and DBP,MAP and mean heart rate of the patients of group-N was significantly higher than that of group-F after drug administration to 5 minute after intubation (p<0.01). 

Conclusion: Intravenous fentanyl (2mcg/kg) controls the stress response to laryngoscopy and intubation  better as compared to i.v nalbuphine (0.2mcg/kg) in geriatric patients but the adverse effect profiles are more in fentanyl arm.


Geriatric, laryngoscopy and intubation, fentanyl, nalbuphine.

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Russell WJ, Morris RG, Frewin D B. Changes in plasma catecholamines concentration during endotracheal intubation. Br J Anaesth.1981; 53:837–9.

Maguire M, Kumar N, Parker JL, Rowbotham DJ, Thompson JP. Comparison of effects of remifentanil and alfentanil on the cardiovascular response to tracheal intubation in hypertensive patients.Br J Anaesth. 2001; 86: 90–93.

Martineau RJ, Tousignant CP, Miller DR. Alfentanil controls the hemodynamic response during rapid sequence induction of anaesthesia. Can J Anaesth. 1990; 37: 755–61.

Jain PN, Divatia JV, Manjshree SS, Chatopadhyay G, Shah SC. Intravenous magnesium inhibits pressure response to nasotracheal intubation. J Anaesth Clin Pharmacol. 1995; 11:59–62.

Minal FN, Khan FA. A comparision of morphine and nalbuphine for intraoperative and postoperative analgesia. J Pak Med Assoc. 2003;53:391–6.

Beaver WT, Felse GA. A comparison of the analgesic effect of intramuscular nalbuphine and morphine in patients with postoperative pain.J Pharmacol Exp Ther. 1978;204:486–96.

Khan FA, Hameedullah. Comparison of fentanyl and nalbuphine in total intravenous anaesthesia (TIVA) J Pak Med Assoc. 2002;52:459–65.

Gallantine EL, Meert TF. A comparison of the antinociceptive and adverse effects of the mu-opioid agonist morphine and the delta-opioid agonist SNC80. Basic Clin Pharmacol Toxicol.2005; 97: 39-51.

Sharma N, Parikh H. comparative study of hemodynamic responses to intubation: fentanyl versus nalbuphine. Gujrat medical journal 2014 ; 69:2.

William M. Splinter, Cervenko F. Haemodynamic responses to laryngoscopy and tracheal intubation in geriatric patients: effects of fentanyl, lidocaine and thiopentone. Canadian Journal of Anaesthesia, 1989; 36: 370.

Bhandari R, Rastogi S, Tyagi A, Joshi A, Malik N, Sachdeva A et al. Attenuation of Haemodynamic Response to Endotracheal Intubation with Nalbuphine and Fentanyl: AComparative Study”. Journal of Evolution of Medical and Dental Sciences 2015; 4 (64) : 11172-11181.


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