Role of pre–extubation fentanyl in mastectomy: a randomized, controlled, double–blind study

  • Ahmed Salman Department of Anesthesiology & Pain Medicine, National Cancer Institute, Kasr Al Eini Street, Fom El–Khalig, Cairo, Egypt.
  • Norma Osama Zayed Department of Anesthesiology & Pain Medicine, National Cancer Institute, Kasr Al Eini Street, Fom El–Khalig, Cairo, Egypt.
  • Ahmed Mansour Department of Anesthesiology & Pain Medicine, National Cancer Institute, Kasr Al Eini Street, Fom El–Khalig, Cairo, Egypt.
  • Ramy Howaidi Department of Anesthesiology & Pain Medicine, National Cancer Institute, Kasr Al Eini Street, Fom El–Khalig, Cairo, Egypt.
  • Ahmed Gamaleldin Foly Department of Anesthesiology & Pain Medicine, National Cancer Institute, Kasr Al Eini Street, Fom El–Khalig, Cairo, Egypt.
  • Mohammed Said ElSharkawy Department of Anesthesiology, Surgical Intensive Care & Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
  • Ahmed Salah Abdelgalil Department of Anesthesiology & Pain Medicine, National Cancer Institute, Kasr Al Eini Street, Fom El–Khalig, Cairo, Egypt.
DOI: https://doi.org/10.35975/apic.v25i2.1462
Keywords: Fentanyl, Pre–Extubation, Mastectomy, Hemodynamics, Recovery

Abstract

Background: Both tracheal intubation and extubation are associated with dangerous consequences such as tachycardia, hypertension, myocardial ischemia and arrhythmias. The aim was to evaluate pre–extubation two different doses of fentanyl on hemodynamic stabilization and delayed recovery in mastectomy.

Methodology: The randomized controlled double–blind study was conducted on 126 patients aged 16–60 years, with controlled hypertension, receiving chemotherapy before surgery and underwent mastectomy for breast cancer. Patients were randomly allocated into 3 equal groups. Before extubation, patients received 10 ml saline in group (C), 1 µg/kg fentanyl in Group–F1: and 2 µg/kg fentanyl in Group–F2. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at T1 (after maintenance of anesthesia), T2 (after giving the test drug), T3 (immediately after extubation), T4 (5 min. after extubation) and T5 (15 min after extubation).

Results: MAP was significantly lower in fentanyl groups compared to Group–C at T2 and T3 without significant deference between fentanyl groups. HR was significantly lower in fentanyl groups compared to Group–C and in Group–F2 compared to Group–F1 at T3, T4 and T5. Time of extubation was significantly prolonged in Group–F2 compared to Group–F1 and Group–C without a significant difference between Group–F1 and Group–C.

Conclusions: Pre–extubation fentanyl 1 µg/kg blunted cardiovascular responses to extubation without respiratory depression or prolonged recovery. Pre–extubation fentanyl 2 µg/kg provide more control in HR but with delay in the extubation time compared to 1 µg/kg of fentanyl.

Key words: Pre–Extubation, Fentanyl, Mastectomy, Hemodynamics, Recovery

Preregistration: The study was registered in the Ethical Committee of Faculty of Medicine, Cairo University, Cairo, Egypt (approval number: 281)

Citation: Salman A, Zayed NO, Mansour A, Howaidi R, Foly AG, ElSharkawy MS, Abdelgalil AS. Role of pre–extubation fentanyl in mastectomy: a randomized, controlled, double–blind study. Anaesth. pain intensive care 2021;25(2):143-149. DOI: 10.35975/apic.v25i2.1462.

Abbreviations: CST=Craniosacral therapy; SMT=Sensorimotor training; NCLBP=Nonspecific chronic low back pain; VAS=Visual analogue scale; ODI=Oswestry disability index, BDI-II=Beck depression inventory-II, and SF-36=Short Form-36; CSF=cerebral spinal fluid; CSS=craniosacral system; PRM=primary respiratory movements

Received: 27 June 2020, Reviewed: 24 July 2020, Accepted: 27 July 2020

Published
04-26-2021
How to Cite
Salman, A., Zayed, N., Mansour, A., Howaidi, R., Foly, A., ElSharkawy, M., & Abdelgalil, A. (2021). Role of pre–extubation fentanyl in mastectomy: a randomized, controlled, double–blind study. Anaesthesia, Pain & Intensive Care, 25(2), 143-149. https://doi.org/10.35975/apic.v25i2.1462
Issue
Vol 25 No 2 (2021): April 2021
Section
ORIGINAL RESEARCH