Comparison of effect of Labetalol and fentanyl with only fentanyl for attenuating pressure responses to intubation and skull pin insertion in neurosurgery

Introduction: Laryngoscopy and intubation as well as application of skull pin in neurosurgical procedure is a highly noxious stimulus which causes hemodynamic changes and can be detrimental in patients with raised intracranial pressure. We studied the effect of addition of intravenous labetalol with fentanyl to attenuate the pressure response to intubation and skull pin insertion in neurosurgery. Materials and Methods: Fifty patients undergoing elective neurosurgical procedure were randomised into two groups as group LF and group F. Patients of group LF received intravenous Labetalol 0.25mg/kg 5 minutes prior and intravenous fentanyl 2µg/kg 3 minutes prior to intubation. Patients of group F received intravenous saline 5 minutes prior and intravenous Fentanyl 2µg/kg 3 minutes prior to intubation. Heart rate (HR) systolic and diastolic blood pressure (SBP and DBP) and mean arterial pressure (MAP) were noted at baseline, after study drug administration, after induction, immediately after intubation, immediately after skull pin insertion, 5 minutes interval till 20 minutes after that. Results: Immediately after intubation HR was 82.60+5.0 per minute in LF group and 97.64 + 4.71 per minute in group F (p=0.01). MAP was higher in group F than group LF (106.84+3.89 mm of Hg, 83.02+3.75 mm of Hg respectively p=0.001). Immediately after skull pin insertion rise in HR (group LF 79.76+5.07 per minute, group F 97.84+4.40 per minute respectively p=0.001) and MAP ( group LF 80.28+5.32 mm of Hg, group F 103.17+7.66 mm of Hg respectively p=0.001) was at lesser extent in group LF. Conclusion: Addition of single dose intravenous labetalol to fentanyl gives better haemodynamic stability to laryngoscopy and intubation as well as skull pin insertion than fentanyl alone.