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Abstract
Background: Esmolol is a cardioselective b-adrenergic antagonist that is used during general anaesthesia to blunt the sympathetic reflex tachycardia and hypertension. The aim of the study was to investigate whether the potential beneficial and adverse effects of esmolol differ depending on the patient age. Methods: A total of 50 ASA I/II patients scheduled for elective upper abdominal surgery were divided in two groups: younger (patients aged up to 35 years) and older (patients older than 65). After premedication with Diazepam, they were infused with esmolol during the first 5 min at a rate of 0.3 mg/kg/min and 0.1 mg/kg/min thereafter. Anaesthesia was induced with thiopental sodium 3-5 mg/kg intravenously (iv) and fentanyl 1.5 µg/kg IV. Tracheal intubation was facilitated with suxamethonium 1-2 mg/kg IV. Long-term neuromuscular blockade was induced with pancuronium bromide 0.07 mg/kg IV bolus and maintained with incremental IV boluses of 0.01 mg/ kg. Inhalational anaesthesia was maintained with a mixture of oxygen and nitrous oxide (O2 /N2 O) 2 : 1. Results: The systolic blood pressure remained constant during the intubation phase in the group of older patients, at the same time being around 89 % of the pre-induction values, while in younger patients it rose up to 100 %. During the same phase of anaesthesia, the diastolic blood pressure in older patients remained at about 91 %, while in younger patients it rose up to 107 % of the pre-induction values. The consumption of drugs and the speed and quality of the recovery from anaesthesia did not differ between the two groups of patients. Conclusion: Infusion of esmolol contributes to the concept of general balanced anaesthesia in elective patients scheduled for upper abdominal surgery equally in younger and older patients.
Highlights
Esmolol – methyl 3-{4-[2-hydroxy-3-(isopropylamino)propoxy]phenyl}propionate hydrochloride - is a selective, hydrosoluble β1-adrenergic receptor blocker described first in 1982 by Zereslinski et al.[1]
All patients received prior to induction of anaesthesia an iv infusion of esmolol in glucose solution 5 %, during the first 5 min at a rate of 0.3 mg/kg/ min and 0.1 mg/kg/min thereafter. This maintenance infusion rate was selected based on the Registration of all major cardiovascular parameters – systolic and diastolic blood pressure and heart rate was performed in critical phases of anaesthesia and intubation: (1) before the induction, (2) induction to anaesthesia, (3) tracheal intubation, (4) first skin incision, (5) surgical manipulation with organs, (6) suture of the surgical wound and (7) tracheal extubation
Systolic and diastolic blood pressure were by 25 % and 19 % higher, while the heart rate was by 14 % lower in elderly patients
Summary
Esmolol – methyl 3-{4-[2-hydroxy-3-(isopropylamino)propoxy]phenyl}propionate hydrochloride - is a selective, hydrosoluble β1-adrenergic receptor blocker described first in 1982 by Zereslinski et al.[1]. Effects of esmolol infusion on cardiovascular parameters and quality of general anaesthesia in younger and older patients. Methods: A total of 50 ASA I/II patients scheduled for elective upper abdominal surgery were divided in two groups: younger (patients aged up to 35 years) and older (patients older than 65). Results: The systolic blood pressure remained constant during the intubation phase in the group of older patients, at the same time being around 89 % of the pre-induction values, while in younger patients it rose up to 100 %. During the same phase of anaesthesia, the diastolic blood pressure in older patients remained at about 91 %, while in younger patients it rose up to 107 % of the pre-induction values. Conclusion: Infusion of esmolol contributes to the concept of general balanced anaesthesia in elective patients scheduled for upper abdominal surgery in younger and older patients
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