Background: Noxious stimuli caused by direct laryngoscopy and endotracheal intubation can produce tachycardia, arrhythmias, and hypertension. These responses are exaggerated in hypertensive patients.

Objective: To compare the effect of esmolol and fentanyl in attenuating the cardiovascular response after intubation in hypertensive patients.

Materials and Methods: The present study was a parallel randomised controlled trial done in a single center. One hundred hypertensive patients that underwent elective surgery requiring general anesthesia with endotracheal intubation were included. Patients were randomly divided into two groups, the esmolol group with 1.5 mg/kg intravenously and the fentanyl group with 2 μg/kg intravenously. Hemodynamic parameters were recorded at baseline, after study drug administration, at intubation, and 10 minutes thereafter. The primary outcomes were blood pressure and heart rate after intubation. Incidences of hypotension and bradycardia were secondary outcomes.

Results: Systolic blood pressure (SBP) after intubation was significantly lower in the fentanyl group than the esmolol group. SBP in the fentanyl group was 15.47 mmHg lower than the esmolol group. Diastolic blood pressure (DBP) in the fentanyl group was 6.96 mmHg lower than the esmolol group. Heart rate after intubation in the fentanyl and esmolol groups was not different. Hypotension was significantly more common in the fentanyl group compared with the esmolol group, while the incidence of bradycardia was not different between the groups.

Conclusion: Intravenous fentanyl 2 μg/kg was more effective at attenuating the blood pressure response to intubation in hypertensive patients than intravenous esmolol 1.5 mg/kg. However, fentanyl should be used cautiously due to the frequent occurrence of hypotension.