EFFICACY OF NALBUPHINE IN ATTENUATION OF HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND OROTRACHEAL INTUBATION

Abstract

Background: Laryngoscopy and orotracheal intubation produce significant hemodynamic responses

including hypertension and tachycardia, which may be detrimental in high-risk patients. Nalbuphine,

a synthetic opioid with both agonist and antagonist properties, may attenuate these cardiovascular

responses. This study aimed to compare the efficacy of nalbuphine versus placebo in controlling

mean arterial blood pressure (MAP) changes during laryngoscopy and intubation.

Materials and Methods: This randomized controlled trial was conducted at the Operation Theatres

of Hayatabad Medical Complex, Peshawar, from March 2024 to December 2024. A total of 122

American Society of Anaesthesiologists (ASA) grade I patients aged 18-60 years undergoing elective

surgery were randomly allocated into two groups. Group A (n=61) received intravenous (IV) saline,

while Group B (n=61) received nalbuphine 0.2 mg/kg IV, five minutes before induction with

propofol and atracurium. MAP was recorded at baseline, three minutes after drug administration,

immediately after intubation, and at one-minute intervals for five minutes post-intubation.

Results: The mean age was 44±12.77 years in Group A and 46±13.12 years in Group B. Group B

demonstrated significantly lower MAP (95.17±4.09 mmHg) compared to Group A (98.33±4.18

mmHg) following intubation (p=0.0001). This significant reduction was consistent across all age

groups, both genders, weight categories, and ASA classification (p=0.0001 for all stratifications).

Conclusion: Nalbuphine represents a safe and effective option for maintaining hemodynamic

stability during airway manipulation.