Comparison of effects of fentanyl,remifentanil and sufentanil on hemodynamic response to endotracheal intubation and myoclonus in elderly patients with etomidate induction

Objective To compare the effects of fentanyl,remifentanil and sufentanil on the hemodynamic response to intubation and myoclonus during etomidate induction in elderly patients. Methods 120 cases(ASA ⅠorⅡ)aged over 65 were randomly assigned to 4 groups. Group C(n = 30) received normal saline 10 mL,group F(n = 30),group S(n = 30) and group R(n = 30) were pretreated with fentanyl 2 μg /kg or sufentanil 0. 2 μg /kg or remifentanil2 μg /kg with continuous infusion of 0. 1 μg /( kg·min) at 1 min before induction with etomidate 0. 2 ~ 0. 3 mg /kg.Endotracheal intubation was performed after administration of cisatracurium 0. 15 ~ 0. 2 mg /kg. Systolic blood pressure(SBP),mean arterial pressure(MAP),heart rate(HR),and the incidence and intensity of myoclonus were recorded.Results After intubation,group R showed significant decrease compared with group C and group F in all of the hemodynamic variables measured. The incidence of increase in SBP and HR more than 30% of the baseline levels,SBP≥180mmHg,HR≥120 beats /min were significantly lower in group R(0,10%,0 and 0) compared with groups C(83%,87%,37% and 30%) and group F(60%,70%,27% and 13%). The frequency and intensity of myoclonus were significantly decreased in three groups(F /R /S) compared with group C. Conclusion Pretreatment with remifentanil can suppress the cardiovascular reactions to endotracheal intubation more effectively than that of fentanyl and sufentanil during etomidate induction. The incidence of myoclonus is significantly decreased in three opioids.