Background and Goal of Study: Lidocaine or opioids were commonly used to attenuate intubation-associated hemodynamic changes (IAHCs) in operating room. Recently, we calculated the effective dose for 95% prevention of hemodynamic changes (ED95) of intravenous oxycodone (0.09 mg/kg) in male patients on the hypothesis that oxycodone may be effective to attenuate IAHCs. Therefore, we investigated the effect of the multiple ED95 of intravenous oxycodone to attenuate IAHCs compared with fentanyl. 

Materials and Methods: After Institutional Review Board approval, 118 male patients, aged between 20 to 65 years old, ASA I or II, were randomly allocated to one of 4 groups. Patients received 0.09 mg/kg (group O1, n=30) or 0.18 mg/kg (group O2, n=27) of intravenous oxycodone 20 min pre-induction, and 15 min later normal saline was injected. Patients received normal saline 20 min pre-induction, and 15 min later 2 µg/kg of fentanyl (group F, n=30) or normal saline (group C, n=31) was injected. Anesthesia induction was performed 3 minute later, and 2 min later endotracheal intubation was performed. We recorded IAHCs (arterial pressures, heart rate) at first injection (baseline), anesthesia induction, intubation, and 1, 3, 5 min post-intubation. The incidences of success were also recorded. If a patient shows within 20 % changes of either arterial pressures or heart rate at 1 min post-intubation compared with baseline values, it is regarded as 'success'. All measured values are presented as mean(95% confidential intervals) or number of patients (%). The statistical analysis was performed by ANOVA test with the Scheffe's post-hoc test, or χ2 test. P < 0.05 was considered to indicate statistical significance. 

Results and Discussion: The incidence of success was highest in group O2 with 81.5%, and followed with group O1 with 70.0%, group F with 53.3%, group C with 16.1% (P < 0.001). The mean arterial pressure (mmHg) at 1 min post-intubation was significantly less in group F [103.2(95.5-110.9),
P = 0.019], O1 [97.3(91.9-102.7), P < 0.001], O2 [94.0(89.3-98.8), P < 0.001] than that in group C [116.1(110.9-121.4)], heart rate was not. The differences of hemodynamic values of between baseline and 1 min post-intubation were significantly less in group F, O1, O2 (lowest) that that in group C (P < 0.001). 

Conclusion: The injection of 0.18 mg/kg of intravenous oxycodone 20 min pre-induction is more effective to attenuate IAHCs with more stable hemodynamics than 2 µg/kg fentanyl.

The intravenous oxycodone is effective to attenuate intubation-associated hemodynamic changes than fentanyl. A prospective, double-blinded, randomized control study