Comparison of the efficacy of esmolol and alfentanil to attenuate the hemodynamic responses to emergence and extubation

Study Objective: To define the ability of esmolol and alfentanil to control the hemodynamic changes associated with extubation and emergence.

Design: Randomized, double-blind, placebo-controlled study.

Setting: General surgery operating rooms at a university hospital.

Patients: Forty-two ASA physical status I and II patients without history of cardiac or pulmonary disease undergoing surgery not involving the cranium or thorax.

Interventions: Patients were given either a bolus dose of normal saline followed by an infusion of normal saline, a bolus dose of alfentanil 5 μg/kg followed by an infusion of normal saline, or a bolus dose of esmolol 500 μg/kg followed by an infusion of esmolol 300 μg/kg/min.

Measurements and Main Results: Emergence and extubation resulted in significant increases in heart rate (HR) and blood pressure (BP) in the placebo group. Alfentanil controlled the responses to emergence but prolonged the time to extubation (p < 0.05). Esmolol significantly controlled the responses to emergence and extubation (p < 0.05).

Conclusions: Emergence and extubation after inhalation general anesthesia result in significant increases in BP and HR in healthy patients. An esmolol bolus dose and subsequent infusion significantly attenuated these responses. A small bolus dose of alfentanil minimized the responses to emergence but prolonged the time to extubation and was no longer protective at that point.