Journal of Isfahan Medical School

Journal of Isfahan Medical School

Specify the Effect of Intranasal and Intravenous Remifentanil on Hemodynamic Changes After Induction and Tracheal Intubation and Comparing with Control Group

Document Type : Original Article(s)

Authors
Seyed Mohammad Reza Safavi 1
Azim Honarmand 1
Pouria Taheri 2
1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v43.i817.0598
Abstract
Background: Laryngoscopy and endotracheal intubation can cause noxious stimulation and increased hemodynamic complications. The aim of this study was to specify the effect of intranasal and intravenous remifentanil on hemodynamic changes after induction and tracheal intubation and comparing it with a control group.
Methods: In this randomized double-blind clinical trial study patients aged 18-65 undergoing general anesthesia, were enrolled from Kashani, AL-Zahra and Amin hospitals in Isfahan during 2018-2019. Patients were divided into three groups: intranasal (IN) remifentanil 4 μg/kg, intravenous (IV) remifentanil 0.5 μg/kg, NS serum with an equivalent volume injected as the remifentanil in the patient groups. Hemodynamic parameters of patients were recorded at baseline, 1 and 3 minutes after induction, and right before laryngoscopy, 1, 3, 5, and 10 minutes after laryngoscopy. ANOVA and chi-square tests were applied to analyze the data.
Findings: No significant difference was observed in the hemodynamic changes of patients including systolic and diastolic blood pressure, mean arterial blood pressure, heart rate, arterial oxygen as well as laryngoscopy grade, duration of anesthesia, surgeon's satisfaction and duration of laryngoscopy between the intravenous and intranasal drug groups (P > 0.05). However, the mean of all variables was significantly different between the study groups (P < 0.05).
Conclusion: Nasal remifentanil, like intravenous remifentanil, was effective in preventing hemodynamic changes during endotracheal intubation and in blunting the associated stimulatory response. The findings of this study can be useful in the healthcare domain.

Highlights

Seyed Mohammad Reza Safavi: Google Scholar

Azim Honarmand: Google Scholar

Keywords
Remifentanil
Hemodynamics
Tracheal
Intubation

Subjects

  1. Verghese ST, Hannallah RS, Brennan M, Yarvitz JL, Hummer KA, Patel KM, et al. The effect of intranasal administration of remifentanil on intubating conditions and airway response after sevoflurane induction of anesthesia in children. Anesth Analg 2008; 107(4): 1176-81.
  2. Favaro R, Tordiglione P, Di Lascio F, Colagiovanni D, Esposito G, Quaranta S, et al. Effective nasotracheal intubation using a modified transillumination technique. Can J Anaesth 2002; 49(1): 91-5.
  3. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's anesthesia e-book. 8th Philadelphia, PA: Elsevier Health Sciences; 2014.
  4. Maldwyn Morgan M, George M. Short practise of anesthesia. London: Chapman and Hall; 1995.
  5. Stone D, Gal T. Airway management, Anesthesia. Edited by Miller R. Philadelphia, Churchill Livingstone; 2000.
  6. Shribman A, Smith G, Achola K. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987; 59(3): 295-9.
  7. Derbyshire D, Chmielewski A, Fell D, Vater M, Achola K, Smith G. Plasma catecholamine responses to tracheal intubation. Br J Anaesth 1983; 55(9): 855-60.
  8. Edwards N, Alford A, Dobson P, Peacock J, Reilly C. Myocardial ischaemia during tracheal intubation and extubation. Br J Anaesth 1994; 73(4): 537-9.
  9. Angst MS. Intraoperative use of remifentanil for TIVA: postoperative pain, acute tolerance, and opioid-induced hyperalgesia. J Cardiothorac Vasc Anesth 2015; 29: S16-S22.
  10. Beers R, Camporesi E. Remifentanil update. CNS Drugs 2004; 18(15): 1085-104.
  11. Maguire A, Kumar N, Parker J, Rowbotham D, Thompson J. Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anaesth 2001; 86(1): 90-3.
  12. Grassin-Delyle S, Buenestado A, Naline E, Faisy C, Blouquit-Laye S, Couderc L-J, et al. Intranasal drug delivery: an efficient and non-invasive route for systemic administration: focus on opioids. Pharmacol Ther 2012; 134(3): 366-79.
  13. Yao Y, Ni J, Yang Y, Guo Y, Ye H, Chen Y. The optimum dose of intranasal remifentanil for laryngeal mask airway insertion during sevoflurane induction in children: a randomized controlled trial. Int J Clin Exp Med 2015; 8(11): 21235-40.
  14. Nho J-S, Lee S-Y, Kang J-M, Kim M-C, Choi Y-K, Shin O-Y, et al. Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation. Br J Anaesth 2009; 103(6): 817-21.
  15. Nasiri E, Soliamani A, Mohammadpour RA, Donyavi R, Jafari H. Comparison between the effectcs of remifentanil and fentanyl on blood pressure and cardiac dysrythmia during tracheal intubation in CABG [in Persian]. J Mazandaran Univ Med Sci 2010; 20(76): 24-31.
  16. Hall A, Thompson J, Leslie N, Fox A, Kumar N, Rowbotham D. Comparison of different doses of remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth 2000; 84(1): 100-2.
  17. Durmus M, Ender G, Kadir BA, Nurcin G, Erdogan O, Ersoy MO. Remifentanil with thiopental for tracheal intubation without muscle relaxants. Anesth Analg 2003; 96(5): 1336-9.
  18. Marashi SM, Nikkhouei RH, Movafegh A, Shoeibi G, Marashi S. Comparison of the effects of magnesium sulfate and remifentanil on hemodynamic responses during tracheal extubation after laparotomy: a randomized double-blinded trial. Anesth Pain Med 2015; 5(4):
  19. Prys-Roberts C, Greene L, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension II: haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971; 43(6): 531-47.
  20. Fletcher R, Olsson K, Helbo‐Hansen S, Nihlson C, Hederstrom P. Oral or nasal intubation after cardiac surgery? A comparison of effects on heart rate, blood pressure and sedation requirements. Anaesthesia 1984; 39(4): 376-8.
  21. Hashemi Aslani S, Ghaffari MH, Marashi M. The effect of remifentanil on the hemodynamic changes of parturients in elective cesarean section by general Anaesthesia [in Persian]. J Sabzevar Univ Med Sci 2010; 16(2): 94-99
  22. Egan TD, Minto CF, Hermann DJ, Barr J, Muir KT, Shafer SL. Remifentanil Versus AlfentanilComparative Pharmacokinetics and Pharmacodynamics in Healthy Adult Male Volunteers. Anesthesiology 1996; 84(4): 821-33.
  23. DeSouza G, Lewis MC, TerRiet MF. Severe bradycardia after remifentanil. Anesthesiology 1997; 87(4): 1019-20.
  24. Nasiri Fermi A, Mortazavi Darazkala Y, Mir Hosseini M. Hemodynamic changes after oral and nasal tracheal intubation in patients under general anesthesia [in Persian]. Scientific Journal of Gorgan University of Medical Sciences 2002, 4(9): 36-41
  25. Rahimi Panahi J, Mahmoudpour A, Negargar S, Azarfarin R. The effect of order of injection of propofol and remifentanil on hemodynamic changes during induction of Anesthesia [in Persian]. J Ardabil Univ Med Sci 2005; 5(2): 142-5.
Journal of Isfahan Medical School
Volume 43, Issue 817
1st Week, August
July and August 2025
Pages 598-607

  • Receive Date 13 May 2025
  • Accept Date 24 June 2025