Open Journal of Anesthesiology, 2019, 9, 167-178

https://www.scirp.org/journal/ojanes
ISSN Online: 2164-5558
ISSN Print: 2164-5531

A Comparative Study between Intravenous

Fentanyl and Intravenous Lidocaine on
Attenuation of Hemodynamic Pressor
Responses to Laryngoscopic Intubation: A
Prospective Cohort Study, Ethiopia

Hirbo Samuel1, Abateneh Melekamayhu1, Misrak Woldeyohannes1, Siryet Tesfaye1,

Tewoderos Shitemaw2*

Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
1

Department of Anesthesia, Arba Minch Health Science College, Arba Minch, Ethiopia
2

How to cite this paper: Samuel, H., Mele- Abstract

kamayhu, A., Woldeyohannes, M., Tesfaye,
S. and Shitemaw, T. (2019) A Comparative Introduction: Laryngoscopic intubation is an insertion of endotracheal tube
Study between Intravenous Fentanyl and into the trachea for maintenance of airway during general anesthesia. Smooth
Intravenous Lidocaine on Attenuation of intubation requires attenuation of pressor responses and maintenance of
Hemodynamic Pressor Responses to La-
ryngoscopic Intubation: A Prospective Co-
baseline hemodynamic stability. The primary outcome of this study is to
hort Study, Ethiopia. Open Journal of Anes- compare intravenous fentanyl and lidocaine as an anesthetics adjuvant on
thesiology, 9, 167-178. attenuation of hemodynamic pressor responses to Laryngoscopic intubation
https://doi.org/10.4236/ojanes.2019.99016 in elective surgical adult patients. Methods: This prospective cohort study
recruits 114 patients who underwent elective surgery under general anesthe-
Received: October 30, 2018
Accepted: September 6, 2019 sia with laryngoscopy and endotracheal tube intubation. The study was con-
Published: September 9, 2019 ducted from January 1, 2018 to March 30, 2018. Systemic random sampling
technique was used to select the study participants. Those patients that re-
Copyright © 2019 by author(s) and
ceived intravenous fentanyl 2 micrograms per kilogram three minutes before
Scientific Research Publishing Inc.
This work is licensed under the Creative intubation as an anesthetics adjuvant are considered as Fentanyl-group (group
Commons Attribution International F). The Lidocaine-group (group L) was those patients who receive 2% intra-
License (CC BY 4.0). venous lidocaine 1.5 milligrams per kilogram three minutes before intubation
http://creativecommons.org/licenses/by/4.0/
as anesthetics adjuvant. Hemodynamic parameters (heart rate and blood
Open Access
pressure) and other variables were documented starting from 3 minutes be-
fore intubation to 5 minutes after intubation. Results: The mean heart rate at
first minute after intubation was significantly lower in fentanyl group (98.91
± 15.6 beats per minute (bpm)) compared to lidocaine (107 ± 15.45 bpm), t
(112) = 2.8, p = 0.006. Systolic blood pressure was also significantly lower in

DOI: 10.4236/ojanes.2019.99016 Sep. 9, 2019 167 Open Journal of Anesthesiology

H. Samuel et al.

fentanyl group (141.9 ± 18.9 millimeters of mercury (mmHg)) compared to

lidocaine (150 ± 18.098 mmHg), t (112) = 2.45, p = 0.016 at first minute after
intubation. At third minute after intubation, heart rate was significantly lower
in fentanyl group compared to lidocaine, t (112), p = 0.037. No difference was
in heart rate and blood pressure among the group at 5th minute after intuba-
tion (p > 0.05). Conclusion and Recommendations: Fentanyl was better on
attenuation of hemodynamic pressor responses to laryngoscopic intubation
when compared to lidocaine. Therefore, using fentanyl pre-operatively to at-
tenuate pressor responses especially during intubation is important.

Keywords
Fentanyl, Hemodynamic Parameters, Hemodynamic Pressor Responses,
Laryngoscopic Intubation, Lidocaine

1. Introduction
Manipulation of the airway is one of the most stressing moments of general
anesthesia. Laryngoscopy, tracheal intubation and other airway manipulations
may cause significant cerebral and systemic hemodynamic responses, including
tachycardia, hypertension, ventricular tachycardia, myocardial ischemia and in-
creased intracranial pressure [1]. It has been suggested that distension of the su-
praglottic tissues is the major cause of the sympatho adrenal response to Laryn-
goscopy [2].
Many drugs and techniques have been used to prevent the hyperdynamic res-
ponses induced by Laryngoscopy and Endotracheal intubation [1] but no single
technique has gained universal acceptance. It is clinically impractical to achieve
sufficient anesthetic depth for preventing hyper dynamic responses to intuba-
tion solely with an intravenous (IV) or inhalational agent. Therefore, a wide
variety of anesthetics drug combinations, adjuvants, or both have been used in
attempting to potentiate anesthetics effects while minimizing hemodynamic de-
pression with varying success rates. Among those dexmedetomidine, beta blocker,
opioids and lidocaine are usually used as adjuvants [3] [4].
Fentanyl brings hemodynamic stability during perioperative period by its ac-
tion on cardiovascular and autonomic regulatory areas. It decreases sympathetic
tone and increases parasympathetic tone. Fentanyl inhibits pituitary adrenal re-
sponse directly or indirectly via hypothalamus. Low doses of fentanyl were em-
ployed because a large dose was led to muscular rigidity, bradycardia, nausea
and vomiting. Large doses may also cause postoperative respiratory depression;
especially in surgery with short duration of less than 1 hour [5].
Lidocaine attenuates the hemodynamic response to tracheal intubation by its
direct myocardial depressant effect, central stimulant effect, and peripheral va-
sodilatory effect and it also suppresses the cough reflex, an effect on synaptic
transmission [6].

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H. Samuel et al.

Hemodynamic pressor responses are a common problem in patients under-

going general anesthesia with laryngoscopic intubation (LI). The mean blood
pressure and heart rate are increased by 30% and 22% respectively from baseline
values during laryngoscopic intubation [7]. Although these changes are only
short-lived and of few consequence in healthy individuals, they may have detri-
mental effects on the coronary or cerebral circulation of high-risk patients [8].
There are many studies done in different countries which compare the effect
of intravenous fentanyl with lidocaine as part of anesthetics adjuvant on attenuation
of hemodynamic pressor responses to laryngoscopic intubation but there are
conflicting results [9] [10] [11] [12]. Hence, the primary outcome of this study is
to compare the post-intubation hemodynamic parameters (heart rate and blood
pressure) between fentanyl and lidocaine group for attenuation of pressor res-
ponses during intubation. The secondary outcomes are to compare the baseline
hemodynamic parameters with post-intubation hemodynamic parameters in
each group.

2. Method
Ethical clearance was obtained from Addis Ababa University ethical clearance
committee before the start of the study. This study was conducted in Tikur An-
bessa specialized Hospital (TASH) which is one of the largest teaching and re-
ferral hospital in Addis Ababa, capital of Ethiopia.
Study design: Institution based comparative observational cohort study was
conducted from Jan 1, 2018 to March 30, 2018.
Source population: All adult patients who were scheduled for elective surge-
ries under general anesthesia with Laryngoscopic intubation at Tikur Anbessa
Specialized Hospital during the study period.
Study population: Patient who underwent elective surgeries under general
anesthesia with Laryngoscopic intubation at Tikur Anbessa Specialized Hospital
during the study period and fulfills inclusion criteria.
Inclusion criteria: ASA I & II patients and Age (18 - 65) years.
Exclusion criteria: Allergy to study drug, Patients receiving cardio vascular
drugs, Patients with difficult intubation, more than one attempt to intubation,
Obstetric patient and Neurosurgical patient were excluded.
Sample size and sampling technique: Sample size was calculated using the
following formula (Comparison of two means) for continuous outcomes based
on a previous study done in India [9] which showed a DBP mean and standard
deviation of 86 ± 4.04 mmHg and 84 ± 3.27 mmHg among the Lidocaine and
Fentanyl groups respectively after intubation. With level of significance being
5%, Z = confidence level at 95% (standard value of 1.96) and power of 80%.

(S 1
2
+ S22 )
(Z α 2 + Zβ )
2
=n
( µ1 − µ2 )
2

where

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H. Samuel et al.

Z α 2 = 1.96 for a p = 0.05 (95% confidence interval).

Z β = 0.84 for 20% beta error.
S = standard deviation.
μ = SBP mean.
( 4.04 ) + ( 3.27 )
2 2

(1.96 + 0.84 )
2
=n
(86 − 84 )
2

n = 53.015956 ≈ 54 patients in each group.

Five percent of additional sample was included by assuming loss to follow up
and a total of 57 samples for each group were calculated.
During the study period, 216 patients were estimated to undergo surgery un-
der general anesthesia with laryngoscopic intubation in the hospital. With sys-
tematic random sampling, every 2nd patients who were scheduled for surgery
under general anesthesia, fulfill inclusion criteria and volunteer were recruited to
take part in the study. Since randomized control trial (RCT) was not yet allowed
in our university, the patients were not randomized for anesthetic management.
Rather by starting at random, every selected participant was placed to either
group based on the responsible anesthetist’s pre-operative hemodynamic pressor
responses management plan (whether they received Fentanyl or lidocaine).
Anesthetic management including pre-operative and intra-operative usage of
anesthetics and anesthetics adjuvant were at the discretion of the personnel
anesthetist assigned to each case. We the investigators did not involve in the
per-operative management of patients. Those patients who received intravenous
fentanyl 2 micrograms per kilogram three minutes before intubation were con-
sidered as group F. The Lidocaine group was defined, in this study, as those pa-
tients who receive intravenous 2% lidocaine 1.5 milligrams per kilogram three
minute before intubation. This continues until the desired sample in each group
was achieved. Participant’s involvement in the study was on voluntary bases,
participants who were not willing to participate in the study & those who wish to
quit their participation at any stage was informed to do so without any restric-
tion.
In the pre-operative period patients were transferred to surgical waiting area
and then to Operation Room (OR). In the OR patients were observed by two
blinded data collectors (anesthetist). The hemodynamic parameters of the pa-
tients were recorded at three minutes before intubation (baseline), first (1st)
minute after intubation, third (3rd) minute after intubation and fifth (5th) minute
after intubation from anesthesia monitoring. Socio-demographic and other fac-
tors are recorded from anesthesia recording sheets and patient’s medical record.
Data were checked for completeness, accuracy and clarity by the investigators.
a) Data processing and analysis:
Data were coded, edited and then entered and cleaned using Epi Info version
7.2 and exported and analyzed using Statistical package for Social Sciences
(SPSS) software version 20.0. Shapiro Wilk test was used to test for distributions
of data while homogeneity of variance was assessed using Levene’s test for

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H. Samuel et al.

equality of variance. Numeric data were described in terms of mean ± SD.

Comparisons of numerical variables between and within study groups were done
using unpaired student t-test (independent t-test) and dependent t-test respec-
tively. Frequency and percentage were used to describe categorical variables and
statistical differences between groups were tested using Chi-square or Fisher’s
exact test, as appropriate. Significance was determined at P value < 0.05.
Operational Definition: the following definitions were used for this study.
Hemodynamic parameters: heart rate, systolic blood pressure and diastolic
blood pressure which were measured and recorded at three minutes before in-
tubation (baseline), 1st minute after intubation, 3rd minute after intubation and
5th minute after intubation.
Fentanyl 2 mcg/kg: The usual dose most commonly used for attenuation
pressor responses during induction of anesthesia.
Lidocaine (2%) 1.5 mg/kg: Intravenous preparation plain lidocaine used for
attenuation of per-operative arrhythmias.
Laryngoscopic intubation (LI): Insertion of flexible tube or airway device in
the trachea by using laryngoscopy.

3. Results
3.1. Demographic and Per-Operative Characteristics
A total of one hundred and fourteen respondents participated in this study. Out
of 114 respondents, 57 were group “F” and 57 were group “L”, all were included
in the study as they were complete and showed the consistency of responses.
Among the study participants who were included in this study, 73 (64%) were
female and 41 (36%) were male. There was no significant difference between two
groups in mean age, mean difference (M) = 0.667, 95% CI [−3.97, 5.3], t (112) =
0.285, p = 0.776, the minimum and maximum ages were 18 and 65 years respec-
tively in group “F’’ and 18 and 62 years in group “L’’. The demographic status
and clinical characteristics of data were comparable between groups with p value
greater than 0.05 (Table 1).

3.2. Comparisons of Heart Rate between Groups

There was no statistical significant difference between the two groups regarding
the baseline (before intubation) heart rate (Table 2). After intubation heart rate
was statistical significantly lower in fentanyl group compared to lidocaine at first
and third minute after intubation (p < 0.006 and p < 0.037 respectively). There
was no statistically significant difference in heart rate among the group at fifth
minute after intubation (p > 0.05) (Table 2).

3.3. Comparisons of SBP between Groups

Independent sample t-test showed that there was no statistical significant dif-
ference at baseline SBP between the groups (p > 0.05). SBP was statistical signif-
icantly lower in fentanyl group compared to lidocaine group at first minute after

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H. Samuel et al.

Table 1. Demographic and clinical characteristics of the study participants who under-
went elective surgery under general anesthesia with laryngoscopic intubation at TASH,
from January 1-March 30, 2018.

Characteristics Fentanyl (n = 57) Lidocaine (n = 57) P-value

Female (n, %) 35 (61.4) 38 (66.7)

Sex 0.558
Male (n, %) 22 (38.6) 19 (33.3)

Age (years) (mean ± SD) 38.5 ± 12.53 39.19 ± 12.45 0.776

Weight (kg) (mean ± SD) 68.9 ± 8.3 67.9 ± 8.5 0.53

I (n, %) 37 (64.9) 37 (64.9)

ASA 0.32
II (n, %) 20 (35.1) 20 (35.1)

I (n, %) 42 (73.3) 42 (73.3)

Mallapatti classification 0.33
II (n, %) 15 (26.3) 15 (26.3)

Propofol (n, %) 30 (52.6) 32 (56.1)

Induction agent 0.50
Thiopental (n, %) 27 (47.4) 25 (43.9)

GI surgery (n, %) 23 (40.4) 15 (26.3)

Gynecology (n, %) 17 (29.8) 16 (28.1)

Surgical procedure ENT (n, %) 4 (7) 7 (12.3) 0.372

Urology (n, %) 5 (8.8) 10 (17.5)

Other (n, %) 8 (14) 9 (15.8)

(n = number of participant, (%) = percentage, ASA = American society of anesthesiology physical status,
SD = standard deviation.).

Table 2. Baseline and after intubation heart rate between fentanyl and lidocaine groups in
the study participants who underwent elective surgery under GA at TASH, from January
1-March 30, 2018.

Heart rate Fentanyl (Mean ± SD) Lidocaine (Mean ± SD) P-value

At Baseline 92.26 ± 18.3 bpm 95.68 ± 16 bpm 0.288

At 1st Min. 98.91 ± 15.6 bpm 107 ± 15.45 bpm <0.006*

At 3rd Min. 94.7 ± 15 bpm 100.6 ± 15 bpm <0.037*

At 5 Min.
th
91.25 ± 15.3 bpm 93.84 ± 15 bpm 0.362

(b/n = between, SD= standard deviation, F = fentanyl, L = lidocaine, At 1st min = at 1st minute after intuba-
tion, At 3rd min = At 3rd minute after intubation, at 5th min = at 5th minute after intubation, * = Statistically
Significant).

intubation (p < 0.016). There was no statistically significant difference in SBP

among the group at third and fifth minute after intubation (p > 0.05) (Table 3).

3.4. Comparisons of DBP between Groups

There was no significant difference between the two groups regarding before
induction (baseline) Diastolic blood pressure (DBP) of the study participants
(p > 0.05). Independent sample t-test showed that DBP was statistical signifi-
cantly lower in fentanyl group compared to lidocaine group at first minute after

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H. Samuel et al.

Table 3. SBP between fentanyl and lidocaine groups in study participants who underwent
elective surgery under GA at TASH, from January 1-March 30, 2018.

SBP Fentanyl (Mean ± SD) Lidocaine (Mean ± SD) P-value

At Baseline 132.19 ± 15 mmHg 132.8 ± 16 mmHg 0.824

At 1 min.
st
141.9 ± 18.9 mmHg 150 ± 18.098 mmHg 0.016*

At 3rd min. 127.7 ± 15.2 mmHg 132.65 ± 16 mmHg 0.094

At 5th min. 120.25 ± 16.8 mmHg 123.19 ± 14.1 mmHg 0.313

(b/n = between, SD= standard deviation, SBP = systolic blood pressure, mmHg = millimeter of mercury, At
1st min = at 1st minute after intubation, At 3rd min = at 3rd minute after intubation, At 5th min = at 5th minute
after intubation, * = statistical significant).

intubation (p < 0.047). There was no statistically significant difference in DBP

among the group at third and fifth minute after intubation (p > 0.05) (Table 4).

3.5. Comparisons of Heart Rate within the Group

The paired sample t-test showed that there was initial rise in heart rate from
baseline at first minute after intubation and third minute after intubation both
in lidocaine and fentanyl group (p < 0.01). At fifth minute after intubation, heart
rate return to baseline and slightly below baseline both in fentanyl and lidocaine
group (p > 0.05) (Table 5).

3.6. Comparisons of SBP within the Group

The paired sample t-test showed that SBP was statistically significantly raised
from baseline at first minute after intubation both in fentanyl and lidocaine
group (p < 0.01). At third minute after intubation SBP return to baseline both in
fentanyl and lidocaine group (p > 0.05). But at fifth minute after intubation SBP
was significantly decreased from baseline in both groups (p < 0.001) (Table 6).

3.7. Comparisons of DBP within the Group

DBP was significantly increased from baseline at first minute after intubation
both in fentanyl and lidocaine group (p < 0.01). At third minute after intubation
DBP return to baseline both in fentanyl and lidocaine group (p > 0.05). But at
fifth minute after intubation DBP was significantly decreased from baseline in
both groups (p < 0.001) (Table 7).

4. Discussion
Stress responses to laryngoscopy and endotracheal intubation in form of tachy-
cardia, hypertension, ventricular tachycardia and arrhythmias may be associated
with significant moribund outcome. This hemodynamic change is due to reflex
sympathetic discharge caused by epipharyngeal and laryngopharyngeal stimula-
tion [2]. Thus, a variety of anesthetics agent combinations and anesthetics adju-
vants have undergone many prospective studies and clinical trials in relation to
study attenuation of pressor responses to laryngoscopic intubation [13].

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H. Samuel et al.

Table 4. DBP between fentanyl and lidocaine group in study participants who underwent elective surgery under GA at TASH,
from January 1-March 30, 2018.

DBP Fentanyl (Mean ± SD) Lidocaine (Mean ± SD) P-value

At Baseline 84.07 ± 10.9 mmHg 84.91 ± 14 mmHg 0.716

At 1st min. 91.7 ± 13 mmHg 95.06 ± 14 mmHg 0.049*

At 3rd min. 82.11 ± 12.6 mmHg 85.63 ± 15 mmHg 0.177

At 5 min.
th
77.02 ± 12 mmHg 80.7 ± 13.4 mmHg 0.125

(SD = standard deviation, DBP = diastolic blood pressure, At 1st min = at 1st minute after intubation, At 3rd min = at 3rd minute after intubation, At 5th min =
at 5th minute after intubation, * = statistically significant).

Table 5. Mean heart rate within fentanyl and lidocaine group in study participants who underwent elective surgery under GA at
TASH, from January 1-March 30, 2018.
Magnitude of raise P-value for mean Magnitude of raise P-value for mean
Fentanyl Lidocaine
Heart rate from baseline in difference with in from baseline in difference within
(Mean ± SD) (Mean ± SD)
F-group F-group L-group L-group
At Baseline 92.26 ± 18.3 bpm - 95.68 ±16 bpm -

At 1st min. 98.91 ±1 5.6 bpm 7.2% ↑ 0.001* 107 ± 15.45 bpm 12%↑ 0.001*

At 3rd min. 94.7 ± 15 bpm 1.11%↑ 0.141 100.6 ± 15 bpm 5.14%↑ 0.001*

At 5 min.
th
91.25 ± 15.3 bpm 1.1%↓ 0.565 93.84 ± 15 bpm 1.9%↓ 0.230

(b/n = between, SD= standard deviation, F = fentanyl, L = lidocaine, At 1st min = at 1st minute after intubation, At 3rd min = At 3rd minute after intubation,
at 5th min = at 5th minute after intubation, ↑ = increase, ↓ = decrease, * = statistically significant, bpm = beat per minute).

Table 6. Mean SBP within fentanyl and lidocaine group in study participants who underwent elective surgery under GA at TASH,
from January 1-March 30, 2018.
Magnitude of P-value for Magnitude of raise
Fentanyl Lidocaine P-value for mean dif-
SBP raise from base- mean difference from baseline
(Mean ± SD) (Mean ± SD) ference within L-group
line In F-group within F-group In L-group
Baseline 132.19 ± 15 mmHg - 132.8 ± 16 mmHg -
At 1st min. 141.9 ± 18.9 mmHg 7.35%↑ 0.001* 150 ± 18.098 mmHg 13%↑ 0.001*
At 3 min.
rd
127.7 ± 15.2 mmHg 3.4%↓ 0.05 132.65 ± 16 mmHg 0.1%↓ 0.896
At 5 min.
th
120.25 ± 16.8 mmHg 6 %↓ 0.001* 123.19 ± 14.1 mmHg 7%↓ 0.001*

(b/n = between, SD = standard deviation, SBP = systolic blood pressure, mmHg = millimeter of mercury, At 1st min = at 1st minute after intubation, At 3rd
min = at 3rd minute after intubation, At 5th min = at 5th minute after intubation, ↑ = increase, ↓ = decrease, * = statistically significant).

Table 7. Mean DBP within fentanyl and lidocaine group in study participants who underwent elective surgery under GA at TASH,
from January 1-March 30, 2018.
Magnitude of raise P-value for mean Magnitude of raise P-value for mean
Fentanyl Lidocaine
DBP from baseline in Difference within F from baseline in difference within
(Mean ± SD) (Mean ± SD)
F-group group L-group L-group
Baseline 84.07 ± 10.9 mmHg - 84.91 ± 14 mmHg -
At 1min. 91.7 ± 13 mmHg 9.07% ↑ 0.001 95.06 ± 14 mmHg 12% ↑ 0.001

At 3min. 82.11 ± 12.6 mmHg 2.3% ↓ 0.232 85.63 ± 15 mmHg 1% ↑ 0.896

At 5min. 77.02 ± 12 mmHg 8% ↓ 0.05 80.7 ± 13.4 mmHg 5% ↓ 0.19

(SD = standard deviation, DBP =diastolic blood pressure, At 1st min = at 1st minute after intubation, At 3rd min = at 3rd minute after intubation, At 5th min =
at 5th minute after intubation, ↑ = increase, ↓ = decrease, * = statistically significant).

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H. Samuel et al.

According to our study the heart rate in bpm with mean ± SD was signifi-
cantly lower in fentanyl group (98.91 bpm ± 15.6 bpm) when compared to lido-
caine group (107 bpm ± 15.45 bpm) at first minute after intubation (p < 0.006).
Heart rate was also lower in fentanyl group compared to lidocaine group at third
minute after intubation (P < 0.037). SBP with mean ± SD was also lower in fen-
tanyl group (141.9 mmHg ± 18.9 mmHg) compared to lidocaine group (150
mmHg ± 18.098 mmHg) at first minute after intubation (p = 0.016). The possi-
ble explanation for this may be Fentanyl brings hemodynamic stability during
peri-operative period by its action on cardiovascular and autonomic regulatory
areas. It decreases sympathetic tone and increases parasympathetic tone.
A randomized control trial study by Jyothsna Yadav et al. (2017) shows simi-
lar finding to our study, comparing fentanyl and lidocaine on attenuation of
hemodynamic responses to laryngoscopic intubation observed that heart rate in
lidocaine group after intubation was 89 bpm ± 2.33 bpm, which was significantly
higher compared to fentanyl group 82.40 bpm ± 1.66 bpm (p = 0.000). The av-
erage increase in heart rate above baseline was significantly lower in fentanyl
group compared to lidocaine group (p = 0.000). The magnitude of increase in
SBP above baseline in lidocaine group and fentanyl group were (9.9%) and
(7.07%) mmHg respectively which was statistically significant (p = 0.000) [9].
Also, a study was done in Korea (2007) showed that the heart rate was signifi-
cantly lower in fentanyl group compared to lidocaine group at first, second and
third minute after intubation (p > 0.05) [14]. Same results were reported in
another study [15].
Our study was in contrary with study done in India (2016) a prospective,
randomized, double-blind study on 120 patients that compare, the effects of li-
docaine, fentanyl, and Esmolol on hemodynamics and bispectral index when
used before laryngoscopy and intubation to prevent stress responses stated that
there were no significant difference between fentanyl (109.80 ± 11.78 bpm) and
lidocaine (103.63 ± 13.813 bpm) in producing hemodynamic stability at first
minute after intubation when compared to each other (p = 0.305) [10].
The result of this study showed the there were no significant difference in SBP
and DBP at third minute after intubation between fentanyl and lidocaine group
(p = 0.413 and 0.194 respectively). In contrary to this study, the randomized
control trial study was done in Turkey (2012) stated that there were significant
difference in SBP and DBP at Third minute after intubation between fentanyl
and lidocaine group (p < 0.05) [11].
Our study found that heart rate was slightly returned to baseline at third
minute and fifth minute after intubation in fentanyl and lidocaine group respec-
tively. This study was in line with prospective studies done in Iran (2017) on 96
patients stated that lidocaine effectively prevents heart rate fluctuations follow-
ing the endotracheal intubation at 3rd and 5th minute after intubation [16].

Limitation of the Study

 Making blind for data collectors was not possible due to operation theatre

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H. Samuel et al.

setup.
 Lack of control group.

5. Conclusion
The findings of our study demonstrate that fentanyl 2 µg/kg IV, administered
three minutes before intubation, was better in attenuating hemodynamic res-
ponses to laryngoscopic intubation compared with 2% lidocaine 1.5 mg/kg IV in
patients undergoing elective surgeries under general anesthesia with laryngos-
copic intubation. But clinically, lidocaine provides a consistent and reliable at-
tenuation of press or responses at fifth minute after intubation as comparable to
fentanyl.

Funding
This work was funded by Addis Ababa University.

Disclosure
The authors have no conflicts of interest to declare.

Availability of Data and Material

The data used in this study was collected by trained data collectors and authors
are willing to share the data upon request from peer researchers.

Acknowledgements
We would like to thank Addis Ababa University College of Medicine and Health
Science for funding this research. Our gratitude goes to supervisors, data collec-
tors and study respondents. Finally, we would like to thank all those, who in one
way or another have contribute to this work.

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this pa-
per.

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DOI: 10.4236/ojanes.2019.99016 177 Open Journal of Anesthesiology

H. Samuel et al.

Abbreviations
ASA—The American Society of Anesthesiologists physical state classification
GA—General Anesthesia
DBP—Diastolic Arterial Pressure
CI—Confidence Interval
SPSS—Statistical Package for Social Science
ETT—Endotracheal Tube
HR—Heart Rate
IV—Intravenous
SBP—Systolic Arterial Pressure
TASH—Tikur Anbessa Specialized Hospital

DOI: 10.4236/ojanes.2019.99016 178 Open Journal of Anesthesiology