Fentanyl in intubation

Q: What is the optimum time to give Fentanyl before intubation to attenuate circulatory responses to laryngoscopy and tracheal intubation?

Answer: About 5 minutes

Laryngoscopy and tracheal intubation are usually accompanied by increases in arterial blood pressure and heart rate. Various methods have been suggested to attenuate these responses, including a beneficial effect of fentanyl.

Fentanyl, at a dose of 2 mcg/kg given 5 minutes before intubation, most effectively attenuated the increases in all four circulatory variables (Heart Rate, Systolic Arterial Pressure, Diastolic Arterial Pressure, and Mean Arterial Pressure).

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References:

1. Small-Dose Fentanyl: Optimal Time of Injection for Blunting the Circulatory Responsesto Tracheal Intubation - Anesth Analg 1998;86:658-61

2. Adachi YU, Satomoto M, Higuchi H, Watanabe K. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anesth Analg. 2002 Jul;95(1):233-7, table of contents. doi: 10.1097/00000539-200207000-00043. PMID: 12088976.

3. Sawano Y, Miyazaki M, Shimada H, Kadoi Y. Optimal fentanyl dosage for attenuating systemic hemodynamic changes, hormone release and cardiac output changes during the induction of anesthesia in patients with and without hypertension: a prospective, randomized, double-blinded study. J Anesth. 2013 Aug;27(4):505-11. doi: 10.1007/s00540-012-1552-x. Epub 2013 Jan 12. PMID: 23314694.