Evaluation of attenuation of intubation response in simulated difficult airway: An entropy™-guided comparison between fentanyl and dexmedetomidine: A randomized, prospective, double-blinded study

Evaluation of attenuation of intubation response in simulated difficult airway: An entropy™-guided comparison between fentanyl and dexmedetomidine: A randomized, prospective, double-blinded study - Background and Aims: Laryngoscopy and endotracheal intubation often trigger a catecholamine surge due to reflex sympathetic stimulation, with more severe pressor responses in difficult airways. This study aimed to evaluate the effectiveness of dexmedetomidine and fentanyl in attenuating hemodynamic responses during simulated difficult intubation scenarios. Secondary outcomes including entropy values, adverse events, and intubation difficulty scale (IDS) scores were also assessed. Materials and Methods: In this randomized, prospective, double-blinded study, 130 patients were divided into two groups: Group F (fentanyl, 2 ?g/kg) and Group D (dexmedetomidine, 1 ?g/kg). After drug administration and induction, a soft cervical collar was applied once state entropy reached 2), and anaesthesia depth (state entropy [SE] and response entropy [RE]), were recorded at baseline, during drug administration, after induction, immediately post-intubation, and at specified intervals up to 10 minutes post-intubation. Adverse events and intubation difficulty scale (IDS) score were also documented. Results: Dexmedetomidine showed superior control of heart rate immediately post-intubation (PPP>0.05). Dexmedetomidine was associated with lower entropy values (P Conclusion: Both dexmedetomidine (1 ?g/kg) and fentanyl (2 ?g/kg) effectively attenuate the intubation response during simulated difficult laryngoscopy and intubation. Dexmedetomidine offers superior heart rate control and depth of anaesthesia compared to fentanyl. Keywords: Airway management; Cervical collar, Simulated difficult intubation; Dexmedetomidine, Fentanyl; Entropy.