Effects of fentanyl versus remifentanyl pretreatment on the QTc interval in patients undergo rapid sequence intubation

Abstract

Rapid intubation (RSI) is the standard method of airway control in emergency patients. One of the complications of laryngoscopy is cardiac dysrhythmia due to increased QT interval. Little research has been done on the effect of opioids in reducing QT during laryngoscopy. The aim of this study was to compare the effect of fentanyl and remifentanil on QTc interval in patients undergoing intubation by rapid method in 1399. Methods: In this study, 50 patients without a history of heart disease and without a history of drug use who were candidates for rapid intubation in the emergency department were selected and divided into two groups. Prior to the injection of intubation drugs, a baseline ECG was obtained from the patient and then randomly assigned to one group of patients with 2 μg / kg fentanyl and the other group with 1 μg / kg remifentanil. Other intubation drugs including lidocaine, atomidite, and succinylcholine were fixed in both groups. Immediately after drug injection and immediately after laryngoscopy, ECG was prepared from patients and QT interval was calculated. The results of each group before and after drug injection as well as the results of the two groups were compared with each other. Results: There was no significant difference in terms of sex distribution and mean age between the two groups of patients. In comparison of QT interval, no statistically significant difference was observed between the two groups receiving fentanyl and remifentanil in any of the studied times (5 minutes before laryngoscopy, one minute after drug injection, immediately after laryngoscopy). In group comparison, changes in QT values during the studied time were statistically significant (P = 0.004). But in comparison between groups, there was no statistically significant difference between the two groups receiving fentanyl and remifentanil (P = 0.235). The results showed that the rate of QT interval changes during three different measurements was increasing in both groups of patients receiving fentanyl and remifentanil. However, this trend did not show a statistically significant difference in pairwise comparison between QT measurements in any of them. Therefore, the use of fentanyl and remifentanil during endotracheal intubation did not have a statistically and clinically significant effect on the QT distance of patients' ECG and the administration of the above two drugs during intubation is safe.