• Shakho Jamal Jalal Shorsh Teaching Hospital, Sulaimani, Kurdistan Region, Iraq.
  • Amir Murad Khudadad College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.




Remifentanil, fentanyl, hemodynamic change, videolaryngoscope, tracheal intubation


Elevation of blood pressure and pulse rate are hemodynamic changes that occur during general anesthesia as a consequence of laryngoscopy and endotracheal intubation ETI, different laryngoscopies and many drugs have been tried to reduce these changes.

To evaluate and compare the efficacy of minimum dose of fentanyl and comparable remifentanil bolus dose during videolaryngoscopic ETI. 

Patients and Methods
A triple blind randomized clinical trial implemented on 224 patients of age group between 16-65 years of either sex (ASA I and ASA II) scheduled for elective operation under general anesthesia with endotracheal intubation, they are randomly assigned into two groups, group A and group B representing both fentanyl and remifentanil as the drug preparation was unknown neither by the patient nor by the researcher and nor by the data analyser, in addition propofol two mg/kg and rocuronium 0.8 mg/kg were given then systolic blood pressure SBP, diastolic blood pressure DBP, mean arterial blood pressure MAP and heart rate HR were recorded in five different occasions as (T0) for baseline preinduction, (T1) one minute before ETI, (T2) one minute after ETI, (T3) three minutes after ETI and (T4) five minutes after ETI.

There was a significant difference in the mean value of HR, SBP, DBP, MAP in both groups before, one, three and five minutes after endotracheal intubation with King vision videolaryngoscope KVVL and one μg/kg remifentanil bolus administration (group B) effectively showed substantial reduction in all hemodynamic parameters with significant statistical result (P < 0.05) when compared to intravenous IV fentanyl one μg/kg (group A). 

Remifentanil bolus of one μg/kg is better than intravenous fentanyl one μg/kg in attenuating hemodynamic response to ETI when KVVL used.


Gropper MA, Miller RD. Miller ´s Anesthesia: Airway management in the adult. 9th ed. Philadelphia:Elsevier; 2020. P 1373-80.

Singh G, Kaur H, Aggarwal S, Sharda G, Singh A, Jha A, et al. Intravenous dexmedetomidine vs. lignocaine in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation: A randomized double blind study. Anaesthesia, Pain Intensive Care. 2017;21(2):181–6.

Neme Doba D, Ferede ZA, Mola Kasa S, Eyob Gebre E, Ayalew N, Abiy Workneh S, et al. Comparison of intravenous fentanyl versus lidocaine for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing elective surgery in Dilla University Referral Hospital, Ethiopia, a randomized controlled trial. Int J Surg Glob Heal. 2020;3(6):e27–e27. DOI: https://doi.org/10.1097/GH9.0000000000000027

Ko DD, Kang H, Yang SY, Shin HY, Baek CW, Jung YH, et al. A comparison of hemodynamic changes after endotracheal intubation by the optiscope TM and the conventional laryngoscope. Korean J Anesthesiol. 2012;63(2):130–5. DOI: https://doi.org/10.4097/kjae.2012.63.2.130

Modir H, Yazdi B, Moshiri E, Mohammadbeigi A, Afshari S. Efficacy of dexmedetomidine versus remifentanil to blunt the hemodynamic response to laryngoscopy and orotracheal intubation: A randomized clinical trial. Med Gas Res. 2018;8(3):85–90. DOI: https://doi.org/10.4103/2045-9912.241065

Bhut C, Shah K, Gaukr N. Clinical evaluation of dexmedetomidine on haemodynamic stress response during laryngoscopy and intubation: A randomized double blind parallel group placebo controlled study. Indian J Clin Anaesth. 2019;6(1):11–8. DOI: https://doi.org/10.18231/2394-4994.2019.0004

Padavarahalli Thammanna P, Marasandra Seetharam K, Channasandra Anandaswamy T, Rath P, Chamanhalli Rajappa G, Joseph J. Comparison of Haemodynamic Response to Intubation with KingVision and C-MAC Videolaryngoscope in Adults. Arch Anesth Crit Care. 2020;6(Spring):65–70. DOI: https://doi.org/10.18502/aacc.v6i2.2761

Gupta A, Bloria P, Atri A, Gulati S. A comparative study of dexmedetomidine versus esmolol for attenuation of cardiovascular response to laryngoscopy and endotracheal intubation. JK Sci. 2019;21(3):113–7.

Cooper RM. Implementing universal videolaryngoscopy: how to do it and what to expect. Br J Anaesth [Internet]. 2018;120(1):13–5. Available from: https://doi.org/10.1016/j.bja.2017.11.017 DOI: https://doi.org/10.1016/j.bja.2017.11.017

Cook TM, Boniface NJ, Seller C, Hughes J, Damen C, MacDonald L, et al. Universal videolaryngoscopy: a structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department. Br J Anaesth [Internet]. 2018;120(1):173–80. Available from: https://doi.org/10.1016/j.bja.2017.11.014 DOI: https://doi.org/10.1016/j.bja.2017.11.014

Elhadi S, Rady W, Elfadly A. A comparative study between the macintosh laryngoscope and the king vision video laryngoscope in endotracheal intubation. Res Opin Anesth Intensive Care. 2016;3(4):168. DOI: https://doi.org/10.4103/2356-9115.195881

Hoshijima H, Maruyama K, Mihara T, Boku AS, Shiga T, Nagasaka H. Use of the GlideScope does not lower the hemodynamic response to tracheal intubation more than the Macintosh laryngoscope: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(48):e23345. DOI: https://doi.org/10.1097/MD.0000000000023345

Upadhyaya S, Pathak L. Hemodynamic changes during orotracheal intubation using Airtraq video laryngoscope and direct laryngoscope: A randomized comparative study. J Soc Anesthesiol Nepal. 2019;6(1):1–8. DOI: https://doi.org/10.3126/jsan.v6i1.24299

Suwarman, Rismawan B, Heiry R. Comparison of 2 μg/kg of fentanyl and 150 μg/kg oxycodone during induction on post-intubation hemodynamics: A randomized clinical trial. Anaesthesia, Pain Intensive Care. 2021;25(1):73–7. DOI: https://doi.org/10.35975/apic.v25i1.1443

Yuan Y, Liu L, Feng S, Ma Y, Wang Q. Effects of different remifentanil doses on the stress reaction and bis value of video laryngoscope-guided tracheal intubation. Trop J Pharm Res. 2018;17(10):2025–30. DOI: https://doi.org/10.4314/tjpr.v17i10.19

Shah B, Mahanta D, Sakhrani R, Boat SA. Comparative Study of Safety and Efficacy of Three Different Doses of Fentanyl on Hemodynamic Response to Laryngoscopy and Tracheal Intubation in Patients under General Anaesthesia. J Pharm Res Int. 2021;33:541–51. DOI: https://doi.org/10.9734/jpri/2021/v33i60A34517

Jheetay GS. Original article : Comparison of Fentanyl , Lignocaine and Placebo on Attenuation of Cardiovascular Responses to Laryngoscopy and Intubation : A Comparative Study. 2013;(6):678–85.

Splinter WM, Cervenko F. Haemodynamic responses to laryngoscopy and tracheal intubation in geriatric patients: effects of fentanyl, lidocaine and thiopentone. Can J Anaesth. 1989;36(4):370–6. DOI: https://doi.org/10.1007/BF03005332

O’Hare R, McAtamney D, Mirakhur RK, Hughes D, Carabine U. Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia. Br J Anaesth [Internet]. 1999;82(2):283–5. Available from: http://dx.doi.org/10.1093/bja/82.2.283 DOI: https://doi.org/10.1093/bja/82.2.283

Whitten CW, White PF. Use of Remifentanil During Anesthetic Induction : 1999;734–6. DOI: https://doi.org/10.1213/00000539-199904000-00007

Carassiti M, Zanzonico R, Cecchini S, Silvestri S, Cataldo R, Agrò FE. Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways: A manikin study. Br J Anaesth. 2012;108(1):146–51. DOI: https://doi.org/10.1093/bja/aer304

Lee RA, Van Zundert AAJ, Maassen RLJG, Willems RJ, Beeke LP, Schaaper JN, et al. Forces applied to the maxillary incisors during video-assisted intubation. Anesth Analg. 2009;108(1):187–91. DOI: https://doi.org/10.1213/ane.0b013e31818d1904

Hogue CW, Bowdle TA, O’Leary C, Duncalf D, Miguel R, Pitts M, et al. A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery. Anesth Analg. 1996;83(2):279–85. DOI: https://doi.org/10.1097/00000539-199608000-00014

Ali QE, Amir SH, Jamil S, Ahmad S. A comparative evaluation of the Airtraq and King Vision video laryngoscope as an intubating aid in adult patients. Acta Anaesthesiologica Belgica. 2015 ;66(3):81-85.

Jagannathan N, Hajduk J, Sohn L, Huang A, Sawardekar A, Albers B, et al. Randomized equivalence trial of the King Vision aBlade videolaryngoscope with the Miller direct laryngoscope for routine tracheal intubation in children <2 yr of age. Br J Anaesth. 2017;118(6):932–7. DOI: https://doi.org/10.1093/bja/aex073



How to Cite

Jalal S, Khudadad A. EFFECT OF REMIFENTANIL BOLUS VS FENTANYL IN ATTENUATING HEMODYNAMIC RESPONSE IN VIDEOLARYNGOSCOPIC ENDOTRACHEAL INTUBATION. JSMC [Internet]. 2023 Jun. 21 [cited 2024 Jul. 20];13(2):8. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10403

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