Perfusion Index to Assess Hemodynamic Changes and Analgesia with Premedication of Fentanyl versus Nalbuphineduring General Anesthesia
Perfusion Index to Assess Hemodynamic Changes
Background: The hemodynamic changes are part of stress responses of airway manipulation and surgical pain, which are manifested as tachyarrhythmia and hypertension, and should be ameliorated. This study compared the hemodynamic changes and analgesia with premedication of fentanyl versus nalbuphine during general anesthesia, using perfusion index technique, a non-invasive parameter.Subjects and Methods:After approval, 60 patients of ASA physical status I and II aged between 26 to 56 years of either gender were randomized in two groups of 30 patients each to receive either intravenous fentanyl 2µg/kg (Group F) or nalbuphine 0.2 mg/kg (Group N), 5 min before induction with propofol. Direct laryngoscopy and intubation was facilitated with vecuronium bromide (0.1 mg/kg). Hemodynamic changes and intraoperative analgesia were recorded at specific time intervals, as primary objectives. Any side effects or complications were noted as secondary outcome.Results:After airway manipulation, the increase in heart rate and systolic blood pressure with decreased perfusion index occurred immediately in patients of both groups which persisted up to 6 to 10 min, thereafter the changes returned back to baseline value with statistically significant difference between both groups. At the time of surgical incision, nalbuphine showed better analgesic effect than fentanyl as assessed by perfusion index. No significant correction between perfusion index and heart rate was observed but there was statistically significant negative correlation between perfusion index and systolic blood pressure.Conclusion: Intravenous fentanyl was more effective for ameliorating the stress response of airway manipulation while nalbuphine was better for intraoperative analgesia as assessed by perfusion index.