Intraoperative use of bolus doses of esmolol to treat tachycardia

A randomized, double-blind, parallel, placebo-controlled study was conducted to determine the safety and efficacy of intravenous (IV) bolus administration of esmolol in treating intraoperative tachycardia in patients undergoing noncardiac general surgery. Forty-eight ASA II-IV patients were randomized into three equal groups to receive either placebo, esmolol 50 mg, or esmolol 100 mg. Premedication (lorazepam) and anesthetic induction techniques (thiopental sodium and succinylcholine) were identical between groups. Approximately 20 minutes after intubation, during isoflurane/N2O/O2 maintenance anesthesia, patients with systolic pressure (SBP) greater than or equal to 110 mmHg were advanced into a 10-minute study drug period if one of two conditions were met: (1) heart rate (HR) was greater than or equal to 95 beats/minute, or (2) an increase in HR of greater than 20% above preinduction baseline occurred. After two consecutive recordings of HR and blood pressure (BP), the study drug (or placebo) was injected. HR was recorded every 30 seconds and BP was recorded every minute during the ensuing 10-minute period. Compared to placebo responses, HR was significantly reduced with both doses of esmolol within 1 minute of bolus injection and remained below placebo levels for 5 minutes after 50 mg of esmolol and for 9.5 minutes after 100 mg of esmolol. There were, however, only minor differences among groups with respect to SBP, diastolic blood pressure (DBP), and mean blood pressure (MBP) changes. Conclusion: Bolus administration of esmolol can produce a rapid reduction of HR with relatively few adverse effects in an unhealthy surgical population.(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparison of propranolol with esmolol for the treatment of tachycardia during emergence from anesthesia

BACKGROUND: Treating tachycardia occurring during emergence from general anesthesia is of the highest priority, because it frequently induces myocardial ischemia. Therefore we retrospectively compared the efficacy of esmolol with that of propranolol against such tachycardia. METHODS: Propranolol (n=22) or esmolol (n= 29) was given intravenously when the heart rate was above 100 beats x min(-1) during emergence from anesthesia. The drugs were titrated to decrease the heart rate the level before the induction of anesthesia. RESULTS: The total dose of propranolol was 0.52+/-0.21 mg (mean+/-SD), which decreased the heart rate significantly from 109.2 +/- 19.0 to 89.2 +/-11.8 beats x min(-1). The total dose of esmolol was 32.8 +/- 16.2 mg, which decreased the heart rate significantly from 110.0+/-13.9 to 84.9+/-10.7 beats x min(-1). The time required for the maximum effect of esmolol (3.2 1.8 min) was significantly shorter than that of propranolol (8.2 +/- 4.9 min). There were no episodes of adverse effects in either group. CONCLUSIONS: Both propranolol and esmolol are equally effective and safe for the treatment of tachycardia during emergence from anesthesia. The time required for the maximum effect of esmolol was shorter than that of propranolol, indicating an advantage of esmolol.     

A bolus dose of esmolol attenuates tachycardia and hypertension after tracheal intubation

Forty-five patients of ASA physical status I and II undergoing a variety of non-cardiac surgical procedures were studied to determine the effect of bolus administration of esmolol, a new short-acting beta blocking drug, on heart rate and blood pressure responses to induction of anaesthesia and tracheal intubation. Subjects were allocated randomly to receive placebo, 100 mg or 200 mg of esmolol IV as part of an anaesthetic induction technique. The differences in heart rate between the placebo group and both the 100 mg and 200 mg groups were significant prior to intubation (95 +/- 7.9, 82 +/- 9.7, 80 +/- 7.3 beats per min respectively), and also at 0.5 min and 1.5 min following intubation for the 200 mg group. In the 200 mg group there was a significant decrease, compared with placebo, in systolic blood pressure at 0.5 min (144 +/- 32.1 vs 165 +/- 18.7 mmHg) and 1.5 min (154 +/- 25.0 vs 170 +/- 19.5 mmHg) after intubation. In this study, adequate haemodynamic control was obtained following administration of 200 mg of esmolol.     

艾司洛尔对丙泊酚麻醉诱导过程中脑电双频指数的影响

目的观察艾司洛尔用于丙泊酚麻醉诱导插管时脑电双频指数(BIS)的变化。方法30例ASAⅠ或Ⅱ级患者随机分为两组,对照组静注生理盐水10ml负荷量后静滴生理盐水,用药组艾司洛尔1mg/kg稀释于生理盐水10ml静注后以250μg.kg-1.min-1微量泵输入,然后静注丙泊酚2mg/kg,当两组BIS降至40~50时静注芬太尼2μg/kg、阿曲库铵0.5mg/kg行经口明视气管插管。监测给药前、诱导前、插管前、插管后1、3、5minBIS、MAP及HR,并观察插管后各时点与插管前BIS、MAP、HR的变化差值△BIS、△MAP及△HR。结果插管前对照组及用药组BIS变化差异无显著意义。插管后1、3、5min对照组BIS较插管前显著升高,用药组BIS与插管前比较差异无显著意义,两组间比较差异有显著意义(P<0.05)。插管后对照组△BIS变化最大百分比为40%,与用药组的6.8%相比差异有极显著意义(P<0.01)。插管后1、3min对照组MAP、HR显著高于插管前,两组比较差异无显著意义;插管后对照组△MAP及△HR变化最大百分比为55%及40%,明显高于用药组的29%及15%。结论艾司洛尔用于丙泊酚麻醉诱导插管时,对插管前BIS无影响,插管后可抑制BIS的增加。     

Bolus administration of landiolol, a short-acting, selective beta1-blocker, to treat tachycardia during anesthesia: a dose-dependent study

OBJECTIVES: The purpose of this study was to clarify the clinical efficacy of landiolol, a selective beta(1)-blocker, in patients developing tachycardia during anesthesia. DESIGN: A prospective, randomized, and placebo-controlled study. SETTING: A single university hospital. PARTICIPANTS: Patients undergoing resection of intracranial or maxillofacial tumors under general anesthesia. INTERVENTIONS: Intravenous bolus administration of landiolol. MEASUREMENTS AND MAIN RESULTS: Patients with heart rates exceeding 90 beats/min for more than 5 minutes received an intravenous bolus dose of landiolol. These patients who developed tachycardia were randomized into 4 groups receiving landiolol in the dose of 0, 0.1, 0.2, or 0.3 mg/kg. Heart rate and blood pressure were recorded before drug injection and 1, 3, 5, 7, 10, 15, 20, 25, and 30 minutes after the injection. Heart rate was significantly reduced with each dose of landiolol compared with the placebo group between 3 and 20 minutes after drug injection. The lowest heart rate was 93 +/- 4, 80 +/- 8, 79 +/- 8, and 77 +/- 6 beats/min (mean +/- standard deviation) in the landiolol 0, 0.1, 0.2, and 0.3 mg/kg groups, respectively. On the other hand, reduction of blood pressure was not as remarkable as that of heart rate. Landiolol, 0.1 and 0.2 mg/kg, did not significantly reduce systolic or diastolic blood pressure during the study period, although significant reduction of blood pressure was observed in the landiolol 0.3-mg/kg group between 5 and 10 minutes after drug injection. CONCLUSION: The results showed that bolus administration of landiolol was effective in the treatment of tachycardia during anesthesia in surgical patients. Landiolol was more efficacious in reducing heart rate than blood pressure.     

艾司洛尔与表面麻醉抑制插管反应时心率变异性的变化

目的比较观察全麻病人气管插管前静脉给予艾司洛尔或用表面麻醉抑制插管反应 时心率变异性(HRV)的变化。方法120例病人随机分为三组,每组40例,Ⅰ组为艾司洛尔组,Ⅱ组为单纯喉气管表面麻醉(LTA)组,Ⅲ组为口咽表面喷雾加LTA组。静注芬太尼2μg·kg-1,异丙酚2mg·kg-1,维库溴铵0．1mg·kg-1诱导插管。Ⅰ组病人插管前2min,静注艾司洛尔2mg·kg-1;Ⅱ组病人用喉镜暴露声门,用1％地卡因2．5ml行会厌、声门及气管内的表面麻醉2min后再行插管;Ⅲ组病人于麻醉前清醒时,用1％地卡因约0．5ml作舌背、软腭、咽及喉部喷雾,其余操作均与Ⅱ组相同。结果除Ⅰ组病人在插管即刻和插管后1min心率明显低于Ⅱ、Ⅲ组外(P<0．05),其它两组病人在插管前后血压、心率均无明显变化。HRV和LF在插管前后只有Ⅲ组保持不变,而Ⅰ、Ⅱ组病人在插管即刻、插管后1min均显著高于Ⅲ组(P<0．01)。Ⅲ组病人的LF／HF在插管即刻及插管后1min出现明显降低(P<0．05),与Ⅰ、Ⅱ组相比有显著性差异。结论插管前静脉注射艾司洛尔不能抑制应激反应的产生;表面麻醉能从根本上抑制应激反应的发生,但在插入喉镜前仍需完善的口咽喉部局麻作保证。     

Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl, or esmolol?

Eighty patients, ASA physical status II-IV, scheduled for noncardiac surgery, were randomly assigned in a double-blind, placebo-controlled manner to receive a preintubation dose of either placebo, 200 mg lidocaine, 200 micrograms fentanyl, or 150 mg esmolol. Induction of anesthesia was accomplished with 4-6 mg/kg thiopental IV followed immediately by the study drug; 1-1.5 mg/kg succinylcholine was given at minute 1. Laryngoscopy and intubation were performed at minute 2 with anesthesia thereafter maintained with 1 MAC (+/- 10%) isoflurane in 60% nitrous oxide in oxygen at a 5 L/min flow for 10 min. Heart rate was recorded every 15 s and blood pressure every minute from induction until 10 min after intubation. Maximum percent increases in heart rate (mean +/- SE) during and after intubation were similar in the placebo (44% +/- 6%), lidocaine (51% +/- 10%), and fentanyl (37% +/- 5%) groups, but lower in the esmolol (18% +/- 5%) group (P less than 0.05). Maximum systolic blood pressure percent increases were lower in the lidocaine (20% +/- 6%), fentanyl (12% +/- 3%), and esmolol (19% +/- 4%) groups than in the placebo (36% +/- 5%) group (P less than 0.05), but not different from each other (P greater than 0.05). Only esmolol provided consistent and reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.     

A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit

The efficacy of a single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension was studied in a double-blind manner. Thirty patients from the Ambulatory Surgery Unit at Rush-Presbyterian-St. Luke's Medical Center were prospectively randomized to receive a placebo, 100 mg of esmolol, or 200 mg of esmolol immediately prior to induction (2.5 to 3.0 minutes before intubation). The groups were similar in demographic characteristics and with regard to preoperative blood pressure (BP) and heart rate (HR). Anesthetic management was standardized for all patients. Esmolol 100 mg (1.4 +/- 0.3 mg/kg) and 200 mg (2.6 +/- 0.7 mg/kg) significantly (p less than 0.05) blunted the maximum increases in HR and BP following intubation. The average maximum HR increase in the placebo group was 40% as opposed to 16% in the esmolol 100 mg group and 14% in the esmolol 200 mg group. Both esmolol groups blunted the tachycardic response over a 4-minute postintubation time period. The average maximum BP increase was 47% in the placebo group versus 22% and 19% in the esmolol 100 mg and esmolol 200 mg groups, respectively. There were no significant differences between the two esmolol groups. This study demonstrates the efficacy of a single bolus dose of esmolol in blunting the tachycardic and hypertensive responses to laryngoscopy and intubation in an ambulatory surgery setting.     

Use of prostaglandin E1 to treat pulmonary hypertension in congenital diaphragmatic hernia

Background/Purpose

Prostaglandin E1 (PGE) has been used to maintain ductus arteriosus patency and unload the suprasystemic right ventricle (RV) in neonates with congenital diaphragmatic hernia (CDH) and severe pulmonary hypertension (PH). Here we evaluate the PH response in neonates with CDH and severe PH treated with PGE.

Landiolol and esmolol prevent tachycardia without altering cerebral blood flow

PURPOSE: Several ss-adrenergic-blocking drugs have been used during electroconvulsive therapy (ECT) to stabilize the hemodynamic alterations following electrical stimulation. The effects of two ultra-short acting ss-adrenergic-blocking drugs, esmolol and landiolol, on systemic and cerebral circulation were studied during ECT. METHODS: In the first study (n = 15), dose-dependent hemodynamic changes were studied when landiolol was administered immediately after induction of anesthesia. In the second study (n = 12), effects of esmolol and landiolol on systemic and cerebral circulation were compared. Patients in Study 1 received three doses of landiolol, and patients in Study 2 received two types of ss-adrenergic-blocking drugs, in a randomized cross-over design in a series of ECT trials. RESULTS: In the first study, 0.25 to 0.5 mg.kg(-1) landiolol induced a lower heart rate after the electrical stimulation compared to vehicle (P < 0.01). Landiolol did not have significant effects on blood pressure. In the second study, heart rate was stabilized by 1.0 mg.kg(-1) esmolol iv or 0.5 mg.kg(-1) landiolol iv. Increase in mean blood pressure was ameliorated by esmolol (P < 0.01), but not by landiolol. Mean cerebral blood flow velocity in the middle cerebral artery increased at one to two minutes after the electrical stimulation regardless of the use of ss-adrenergic-blocking drugs (P < 0.01). Muscular and electroencephalographic seizure durations were not significantly altered by the ss-adrenergic-blocking drugs. CONCLUSION: Landiolol suppresses heart rate elevation during ECT without affecting blood pressure. Cerebral blood flow velocity in the middle cerebral artery is not affected by the use of either esmolol or landiolol.     

Recurrent ST-segment elevation on ECG and ventricular tachycardia during neurosurgical anesthesia

This article reports an unusual case of repeated intraoperative myocardial ischemia and ventricular arrhythmia during neurosurgical anesthesia. The presentation was clinically diagnosed as coronary spasm after successful resuscitation. Intraoperative prostaglandin E₁ and β-adrenergic blockade, as well as vagal stimulation due to surgical manipulation, may have contributed to the episode.     

瑞芬太尼复合艾司洛尔对全麻患者气管插管时心血管指标的影响

目的 评价瑞芬太尼复合艾司洛尔对全麻患者气管插管时心血管系统的影响.方法 选择择期上腹部手术患者60 例,ASAⅠ - Ⅱ级,随机分为3 组（n = 20）：瑞芬太尼2 μg/kg组（Ⅰ组）,芬太尼4 μg/kg ＋ 艾司洛尔1 mg/kg 组（Ⅱ组）和瑞芬太尼2 μg/kg ＋ 艾司洛尔1 mg/kg组（Ⅲ组）.分别注入上述药物、丙泊酚2 mg/kg 和阿曲库铵1.5 mg/kg 后行气管插管,机械通气.记录麻醉诱导前（T1）、麻醉诱导后1 min（T2）、气管插管后即刻（T3）、气管插管后1 min（T4）、3 min（T5）及10 min（T6）的HR、收缩压（SP）、舒张压（DP）,并于T1、T2、T4 时分别采集桡动脉血7 ml,测定血浆肾上腺素（Ad）和去甲肾上腺素（NA）的浓度.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组HR、SP、DP 及血浆Ad 和NA 的浓度降低（P 〈 0.05）;与Ⅱ组比较,Ⅲ组HR、SP、DP 降低（P 〈 0.05）;与T1 比较,T2时3 组HR、SP、DP 及血浆Ad 和NA 的浓度降低（P 〈 0.05）;Ⅰ组T3 时HR、SP、DP 升高,Ⅱ组和Ⅲ组差异无统计学意义.结论 瑞芬太尼复合艾司洛尔可更好地预防全麻患者气管插管时的心血管副作用.     

The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery

We compared esmolol and remifentanil infusions with respect to their effect on intraoperative hemodynamic stability and early recovery after outpatient laparoscopic surgery when administered as IV adjuvants during desflurane anesthesia. After premedication with midazolam 2 mg IV, anesthesia was induced with propofol 2 mg. kg(-1) IV in combination with either esmolol 1 mg. kg(-1) IV (n = 27) or remifentanil 1 microg. kg(-1) IV (n = 26) and succinylcholine 1 mg. kg(-1) IV according to a randomized, double-blinded protocol. Anesthesia was initially maintained with desflurane 2.5% (subsequently titrated to maintain an electroencephalogram-bispectral index value of 60) and nitrous oxide 65% in oxygen. Before skin incision, an infusion of either esmolol (5 microg. kg(-1). min(-1)) or remifentanil (0.05 microg. kg(-1). min(-1)) was started and titrated to maintain the heart rate within 25% of the baseline value. Mivacurium, 0.04 mg/kg IV, bolus doses were administered to maintain a stable peak inspiratory pressure. Esmolol (12.8 +/- 13.1 microg. kg(-1). min(-1)) and remifentanil (0.04 +/- 0.02 microg. kg(-1). min(-1)) infusions were equally effective in maintaining a stable heart rate during these laparoscopic procedures. Although the mivacurium requirement was larger in the Esmolol group (7 +/- 5 vs 3 +/- 4 mg), the Esmolol group reported a smaller incidence of postoperative nausea and vomiting (4% vs 35%). Both drugs were associated with frequent "postanesthesia care unit bypass" rates (78-81%), short times to "home readiness" (119-120 min), excellent patient satisfaction (81-85%), and rapid resumption of normal activities (2.6-3.2 d). Fast-tracked patients were ready for discharge home significantly earlier (112 +/- 46 vs 151 +/- 50 min). We concluded that esmolol infusion is an acceptable alternative to remifentanil infusion for maintaining hemodynamic stability during desflurane-based fast-track anesthesia for outpatient gynecologic laparoscopic surgery.