| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Canadian Journal of Anesthesia, Vol 38, 849-858, Copyright © 1991 by Canadian Anesthesiologists' Society
ARTICLES |
DR Miller, RJ Martineau, JE Wynands and J Hill
Department of Anaesthesia, Ottawa General Hospital, Ontario.
A multicentre trial was designed to determine the dose-response and side-effects of esmolol when administered as a single iv bolus prior to induction of anaesthesia for controlling the haemodynamic response to tracheal intubation. Five hundred and forty-eight patients from 12 university-affiliated centres across Canada were randomized prospectively to receive either placebo (PLAC) or esmolol (E) in a dose of 100 mg (E100) or 200 mg (E200). Study medication was given immediately before induction of anaesthesia with thiopentone 3-5 mg.kg-1 and succinylcholine 1.5 mg.kg-1. Low-dose narcotic (fentanyl 2-3 micrograms.kg-1 or sufentanil 0.3 micrograms.kg-1) or moderate dose narcotic (fentanyl 4-7 micrograms.kg-1) was also given at five of the participating centres, whereas patients in the remaining seven centres received no narcotic. Patients who received PLAC and no narcotic had greater HR and SBP values after tracheal intubation than patients who received either E100 or E200 (P less than 0.005). The proportion of patients whose maximum HR exceeded 110 min-1 was also greater in the PLAC group (22/180) than in either the E100 (10/187) or E200 (9/181) groups (P less than 0.05), but was not different when comparing E100 with E200. Esmolol was less effective in controlling blood pressure, but, in combination with low-dose narcotic, esmolol suppressed the SBP response to tracheal intubation. In the presence of moderate-dose narcotic, however, a decrease in SBP occurred in all three groups following induction of anaesthesia (P less than 0.003), with the largest decrease (17 +/- 4%) occurring in patients who had received E200. The overall incidence of hypotension (SBP less than 90 mmHg) was greater in the E200 group (33%) than either the E100 (25%) or PLAC (16%) groups (P less than 0.05). Other side-effects, such as bradycardia, bronchospasm or pain on injection, occurred no more frequently in either esmolol group than with placebo. It is concluded that a 100 mg bolus of esmolol is safe and effective for controlling the haemodynamic response to tracheal intubation. This dose of esmolol combined with a low dose of narcotic (fentanyl 2-3 micrograms.kg-1 or equivalent) results in effective control of both heart rate and blood pressure, while avoiding important side-effects.
This article has been cited by other articles:
 |
|
 |
|
  T. Ozturk, H. Kaya, G. Aran, M. Aksun, and S. Savaci Postoperative beneficial effects of esmolol in treated hypertensive patients undergoing laparoscopic cholecystectomy Br. J. Anaesth., February 1, 2008; 100(2): 211 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242. [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): e418 - e500. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Zhao, T. Sugawara, S. Miura, T. Iijima, and S. Kashimoto Intrathecal landiolol inhibits nociception and spinal c-Fos expression in the mouse formalin test: [Le landiolol intrathecal inhibe la nociception ainsi que l'expression rachidienne de c-Fos lors du test de formaline chez la souris] Can J Anesth, March 1, 2007; 54(3): 201 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy -- A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Anesth. Analg., January 1, 2007; 104(1): 15 - 26. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Wiesbauer, O. Schlager, H. Domanovits, B. Wildner, G. Maurer, M. Muellner, H. Blessberger, and M. Schillinger Perioperative {beta}-Blockers for Preventing Surgery-Related Mortality and Morbidity: A Systematic Review and Meta-Analysis Anesth. Analg., January 1, 2007; 104(1): 27 - 41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and Biology J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2343 - 2355. [Full Text] [PDF]
|
|
|
|
 |
|
 P J Devereaux, W S. Beattie, P. T-L Choi, N. H Badner, G. H Guyatt, J. C Villar, C. S Cina, K. Leslie, M. J Jacka, V. M Montori, et al. How strong is the evidence for the use of perioperative {beta} blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials BMJ, August 6, 2005; 331(7512): 313 - 321. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Y. Chia, M. H. Chan, N. H. Ko, and K. Liu Role of {beta}-blockade in anaesthesia and postoperative pain management after hysterectomy Br. J. Anaesth., December 1, 2004; 93(6): 799 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Menigaux, B. Guignard, F. Adam, D. I. Sessler, V. Joly, and M. Chauvin Esmolol prevents movement and attenuates the BIS response to orotracheal intubation{dagger} Br. J. Anaesth., December 1, 2002; 89(6): 857 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Zaugg, M. C. Schaub, T. Pasch, and D. R. Spahn Modulation of {beta}-adrenergic receptor subtype activities in perioperative medicine: mechanisms and sites of action Br. J. Anaesth., January 1, 2002; 88(1): 101 - 123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Johansen Esmolol Promotes Electroencephalographic Burst Suppression During Propofol/Alfentanil Anesthesia Anesth. Analg., December 1, 2001; 93(6): 1526 - 1531. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Atlee, M. S. Dhamee, T. L. Olund, and V. George The Use of Esmolol, Nicardipine, or Their Combination to Blunt Hemodynamic Changes After Laryngoscopy and Tracheal Intubation Anesth. Analg., February 1, 2000; 90(2): 280 - 280. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. B. Wiest, S. S. Garner, W. E. Uber, and R. M. Sade Esmolol for the management of pediatric hypertension after cardiac operations J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 890 - 897. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
