ATTENUATING EXTUBATION RESPONSE WITH FENTANYL - CLINICAL REVIEW

Background: Tracheal extubation elicits profound sympathoadrenal activation, manifesting as tachycardia, hypertension,cough,and airway hyperreactivity.This study evaluated the efficacy of a pre-emptive 100 mcg intravenous fentanyl bolus administered 10 minutes pre-extubation to attenuate this response.Methods:A prospective,randomized, double-blind trial enrolled 16 ASA PS I-II adults (25–60 years) undergoing elective surgery with endotracheal intubation >60 minutes. Participants received either fentanyl 100 mcg IV (n=8) or no intervention (n=8). Primary endpoints included hemodynamic stability (HR, SBP/DBP), extubation quality (4-point Extubation Quality Scale,EQS), and cough suppression (Cough Severity Score, CSS). Secondary metrics encompassed respiratory parameters (SpO2, RR, rapid shallow breathing index [RSBI]) and adverse events. Results: Fentanyl significantly attenuated hemodynamic perturbations (mean HR: -25±5 bpm vs. +36±10 bpm in control, p<0.001; SBP: -30±7 mmHg vs. +40±11 mmHg, p<0.001), reduced median CSS (1 [IQR 0-1] vs. 3 [IQR 2-3],p<0.01), and optimized EQS (median score 2 [IQR 1-2] vs. 3 [IQR 3-4],p=0.004).However,25% of fentanyl recipients experienced transient respiratory depression (SpO₂ 94±2% vs. 98±1% at T+5 min,p=0.03),with elevated RSBI (97±14 vs. 64±9,p=0.01), necessitating supplemental oxygen. Sedation scores (RASS) were significantly lower post-extubation (median RASS: -2 [-3, -1] vs. 0 [0, 0], p<0.01), with no clinically significant bradycardia.Conclusion: Pre-extubation fentanyl bolus (100 mcg) effectively blunts sympathoadrenal responses but requires vigilant respiratory monitoring.Its utility is optimal in hemodynamically labile patients without baseline respiratory compromise.