Effect of intravenous bolus esmolol on changes in heart rate during laryngoscopy and endotracheal intubation under general anesthesia in patients with mitral stenosis posted for closed mitral commissurotomy

Abstract

Background: Maintenance of an optimal heart rate during laryngoscopy and endotracheal intubation is a key factor in the management of patients with mitral stenosis undergoing surgery under general anesthesia to minimize mortality. Esmolol is a rapid-onset and short-acting selective β1-blocker. Objective: To compare the effect of narcotic induction with and without intravenous bolus dose of esmolol on the changes in heart rate in response to laryngoscopy and endotracheal intubation in patients with mitral stenosis posted for closed mitral commissurotomy. Materials and Methods: Twenty patients of either sex, of age between 18 and 40 years with mitral stenosis posted for closed mitral commissurotomy, and without overt heart failure, other significant valvular disease, significant cerebrovascular disease, bronchial asthma, anticipated difficult airway, in rhythm other than sinus, heart block more than first degree, and already receiving a β-blocker or antihypertensive were allocated randomly to receive either normal saline (Group A, control group) or esmolol (Group B, study group) along with narcotic induction. Result: The median heart rate in Group B patients was significantly lower just before laryngoscopy, 1 min postintubation, and 2 min postintubation time points in comparison to Group A (Mann–Whitney U test). A serial change in the median heart rate was found to be statistically significant p < 0.05 (Friedman’s analysis of variance) in Group A and nonsignificant in Group B. Conclusion: Here, esmolol was found to be beneficial to obtund the heart rate response during intubation, especially in patients with mitral stenosis without any untoward responses.