Tracy McClinton, DNP, APRN, AGACNP, EBP-C; Dwayne Accardo, DNP, CRNA, FAANA
Investigative Techniques | Medicine and Health Sciences | Nursing
Endotracheal intubation and laryngoscopy potentiate the cardiovascular response in the form of hypertension, tachycardia, and ventricular arrhythmias. Suppression of this adrenergic response is necessary to ensure patient safety. Currently, anesthesia providers employ many methods to attenuate the sympathetic response without established guidelines. As such, our project aimed to determine the effectiveness of fentanyl compared to esmolol in attenuating the hemodynamic response during laryngoscopy and endotracheal intubation within the first five minutes and throughout the intraoperative period.
A literature review was completed of ten critically appraised articles from the years 2011-2022. Articles in the review included randomized control studies, peer reviews, evidence-based practice, comparative studies, and meta-analyses. All articles included must have addressed fentanyl or esmolol groups associated with hemodynamics before and after intubation. A level of evidence outcomes table was composed to provide a synthesis of results from the ten chosen articles.
Of the multiple articles reviewed, the majority concluded fentanyl was the better choice to administer before induction for attenuating hemodynamic responses to intubation. Many studies differ in the patient populations evaluated, but overall, fentanyl caused the least number of hypertensive episodes. Esmolol was typically more effective on the heart rate response, while the combination of the two medications was more effective on the arterial pressure. However, such combination resulted in significant post-intubation hypotension, requiring an immediate response.
Implications for Nursing Practice
Results provided in this scoping review afforded the authors a diverse level of evidence that using fentanyl or esmolol can attenuate hemodynamic responses to endotracheal intubation. The individual need of each patient is highly regarded as the decision-making aspect of each case, with fentanyl as the preferred agent for overall hemodynamic stability. These findings suggest further evaluations regarding patient individualization are needed when choosing the appropriate drug for attenuating the hemodynamic response to intubation.
King, Carlie; Kirby, Robert; Groome, Mitchell; Gubin, Cassidy; McClinton, Tracy DNP, APRN, AGACNP, EBP-C; and Accardo, Dwayne DNP, CRNA, FAANA , "Esmolol Compared to Fentanyl for Hemodynamic Attenuation during Intubation: A Scoping Review" (2023). Doctor of Nursing Practice Projects. Paper 67. http://dx.doi.org/10.21007/con.dnp.2023.0067.