• Seyed-Mohamad Mireskandari, Navid Abulahrar, Mohamad-Esmaeil Darabi, Iman Rahimi, Fatemeh Haji-Mohamadi, and Ali Movafegh.
• Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran ; Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran.
• Iran J Pediatr. 2011 Jun 1;21(2):173-80.

ObjectiveLaryngoscopy and tracheal intubation may cause significant cerebral and systemic hemodynamic responses. Many drugs have been shown to be effective in modifying these hemodynamic responses, including fentanyl, sufentanil, alfentanil and remifentanil. The purpose of the current study was to compare the efficacy of fentanyl, sufentanil, alfentanil and remifentanil on blunting cardiovascular changes during laryngoscopy and intubation in children.MethodsEighty children, 1-6 years old, classified as American Society of Anesthesiologists physical status I and II who were scheduled for elective surgery with general anesthesia and orotracheal intubation, were enrolled in this randomized and double-blinded study. Patients were randomly assigned into four groups of 20 patients. Group F received fentanyl 1µg/kg(-1), group S received sufentanil 0.1 µg/kg(-1), group A received alfentanil 10 µg/kg(-1) and group R received remifentanil 1 µg/kg(-1) intravenously. After establishment of neuromuscular blockade confirmed with a nerve stimulator, laryngoscopy and orotracheal intubation were performed 3 min after induction. Hemodynamic variables including systolic and diastolic blood pressure (SAP, DAP) and heart rate (HR) were recorded at base line (before opioid administration), before laryngoscopy and one minute after orotracheal intubation.FindingsThe patients' characteristics and laryngoscopy grade were similar in all groups. There was no significant difference in the mean values of SAP, DAP and HR at each measured time between the four groups. There was significant difference in the mean values of SAP, DAP and HR measured over time in each group.ConclusionThe intravenous fentanyl attenuated laryngoscopy-induced SAP, DAP and HR increases better than sufentanil, alfentanil or remifentanil and hemodynamic stability is better preserved with fentanyl.

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