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Clinical Research Article

Korean J Anesthesiol 2012 August 63(2): 124-129
http://dx.doi.org/10.4097/kjae.2012.63.2.124

Comparison of dexmedetomidine and remifentanil for
attenuation of hemodynamic responses to laryngoscopy
and tracheal intubation
Jeong Han Lee, Hyojoong Kim, Hyun-Tae Kim, Myoung-Hun Kim, Kwangrae Cho, Se Hun Lim,
Kun Moo Lee, Young-Jae Kim, and Chee-Mahn ShinDepartment of Anesthesiology and Pain Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea

Background: This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic
induction on hemodynamic change after direct laryngoscopy and tracheal intubation.
Methods: A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3groups to receive one of the
following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 μg/kg (Group
D, n = 30), remifentanil 1 μg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium
0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine
1 μg/kg was infused for 10 min beforetracheal intubation. Patients in group R was received 1 μg/kg of remifentanil 1
minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded
from entrance to operation room to 5 min after tracheal intubation.
Results: The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R
weresignificantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in
groups R and D than in the group C (P < 0.05).
Conclusions: In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed
a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal
intubation. (Korean JAnesthesiol 2012; 63: 124-129)
Key Words: Dexmedetomidine, Endotracheal intubation, Hemodynamics, Remifentanil.

Received: January 4, 2012. Revised: 1st, February 14, 2012; 2nd, March 14, 2012. Accepted: March 20, 2012.
Corresponding author: Jeong Han Lee, M.D., Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, College of Medicine, Inje
University, Gaegeum 2-dong,Busanjin-gu, Busan 614-735, Korea. Tel: 82-51-890-6520, Fax: 82-51-898-4216, E-mail: ljh646@daum.net
CC T his is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://
creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium,
provided the original work is properlycited.

Copyright ⓒ the Korean Society of Anesthesiologists, 2012

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Korean J Anesthesiol

Lee, et al.

Introduction
Laryngoscopic manipulation and endotracheal intubation,
for anesthetic induction, increases the release of catecholamine
by stimulating the sympathetic nervous system, which results in
the elevation of blood pressure, heart rate, and arrhythmia [1,2].This response could lead to severe situations like myocardial
ischemia for patients who have risk factors of hypertension and
ischemic heart diseases [3]. For these reasons, local anesthetics,
beta blockers, and opioids have been used in order to prevent
c hanges in the cardiovascular system when endotracheal
intubation is carried out [4-6].
Fentanyl, sufentanil and other opioid agents havebeen
studied to prevent cardiovascular changes due to interventions
associated with anesthesia. However, remifentanil, the most
recently introduced opioid, serves as an adequate opioid due to
a small volume of distribution, and its rapid clearance in cases
of endotracheal intubation; in which dynamic hemodynamic
changes can occur within a short period of time [7].
Clonidine, which is an...